Provider Demographics
NPI:1376774190
Name:FARRELL, ANITA GAIL (PHD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:GAIL
Last Name:FARRELL
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 1:2901 OHIO BLVD STE 116-7
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2239
Mailing Address - Country:US
Mailing Address - Phone:812-917-7151
Mailing Address - Fax:812-638-4110
Practice Address - Street 1:2901 OHIO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2239
Practice Address - Country:US
Practice Address - Phone:812-232-2144
Practice Address - Fax:812-234-4598
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN20042799A103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health