Provider Demographics
NPI:1104023068
Name:FAHRINGER, MARILYN SUE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:SUE
Last Name:FAHRINGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 TOM FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-3510
Mailing Address - Country:US
Mailing Address - Phone:865-414-0388
Mailing Address - Fax:865-475-9409
Practice Address - Street 1:544 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-7406
Practice Address - Country:US
Practice Address - Phone:865-414-0388
Practice Address - Fax:865-475-9409
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist