Provider Demographics
NPI:1164601084
Name:FARMER, SALLY (PHD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18582
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-0582
Mailing Address - Country:US
Mailing Address - Phone:775-687-7573
Mailing Address - Fax:775-687-7544
Practice Address - Street 1:834 WILLOW ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1304
Practice Address - Country:US
Practice Address - Phone:775-687-7573
Practice Address - Fax:775-687-7544
Is Sole Proprietor?:No
Enumeration Date:2007-10-27
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0475103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100737Medicare PIN