Provider Demographics
NPI:1356088090
Name:FARRAR, AMBER NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:FARRAR
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 1:611 E KIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6400
Mailing Address - Country:US
Mailing Address - Phone:573-606-9949
Mailing Address - Fax:
Practice Address - Street 1:611 E KIMBERLY ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6400
Practice Address - Country:US
Practice Address - Phone:573-606-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-23-68111103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst