Provider Demographics
NPI:1417132051
Name:FARRAR, DONNA R (MA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:R
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DEDE
Other - Middle Name:
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:350 ELK ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7351
Mailing Address - Country:US
Mailing Address - Phone:605-343-7262
Mailing Address - Fax:
Practice Address - Street 1:350 ELK ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7351
Practice Address - Country:US
Practice Address - Phone:605-343-7262
Practice Address - Fax:605-343-7262
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3682101YM0800X
NE1832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional