Provider Demographics
NPI:1164846796
Name:FARRELL, DONNA (PHD, LSSP)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PHD, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46721 IH 10
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-8499
Mailing Address - Country:US
Mailing Address - Phone:409-296-8612
Mailing Address - Fax:409-296-2548
Practice Address - Street 1:46721 IH 10
Practice Address - Street 2:
Practice Address - City:WINNIE
Practice Address - State:TX
Practice Address - Zip Code:77665-8499
Practice Address - Country:US
Practice Address - Phone:409-296-8612
Practice Address - Fax:409-296-2548
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6306 / 14885103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool