Provider Demographics
NPI:1164191250
Name:FARRAR, HOLLY (LPC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:FARRAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 N 16TH ST UNIT 15
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1055
Mailing Address - Country:US
Mailing Address - Phone:602-717-6185
Mailing Address - Fax:
Practice Address - Street 1:6739 N 16TH ST UNIT 15
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1055
Practice Address - Country:US
Practice Address - Phone:602-717-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20161OtherLPC