Provider Demographics
NPI:1487208104
Name:ANDERSON, FARAH E (LCPC)
Entity Type:Individual
Prefix:MS
First Name:FARAH
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 7TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-1462
Mailing Address - Country:US
Mailing Address - Phone:309-316-3500
Mailing Address - Fax:
Practice Address - Street 1:1033 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-1462
Practice Address - Country:US
Practice Address - Phone:309-316-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health