Provider Demographics
NPI:1477941540
Name:FARLEY, JESSICA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 N COURT ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1766
Mailing Address - Country:US
Mailing Address - Phone:419-575-1978
Mailing Address - Fax:419-710-6334
Practice Address - Street 1:799 N COURT ST STE 11
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1766
Practice Address - Country:US
Practice Address - Phone:419-575-1978
Practice Address - Fax:419-710-6334
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0291204Medicaid