Provider Demographics
NPI:1477682037
Name:FARRER, TONYA DAWN (MA, LLP, CAAC)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:DAWN
Last Name:FARRER
Suffix:
Gender:F
Credentials:MA, LLP, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8435 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1812
Mailing Address - Country:US
Mailing Address - Phone:810-424-2100
Mailing Address - Fax:
Practice Address - Street 1:8435 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1812
Practice Address - Country:US
Practice Address - Phone:810-424-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009645104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0997622OtherHEALTH PLUS OF MICHIGAN
MI1014832OtherMCLAREN