Provider Demographics
NPI:1164699096
Name:FARRELL FAMILY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:FARRELL FAMILY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STARKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-993-9024
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-0726
Mailing Address - Country:US
Mailing Address - Phone:662-993-9024
Mailing Address - Fax:662-993-9025
Practice Address - Street 1:118 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2009
Practice Address - Country:US
Practice Address - Phone:662-993-9024
Practice Address - Fax:662-993-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC62871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty