Provider Demographics
NPI:1508239229
Name:FARRIS, CHARLOTTE (LPCC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:FARRIS
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 1:29 N MAYSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1471
Mailing Address - Country:US
Mailing Address - Phone:859-520-3041
Mailing Address - Fax:859-432-8935
Practice Address - Street 1:29 N MAYSVILLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1471
Practice Address - Country:US
Practice Address - Phone:185-952-0304
Practice Address - Fax:859-432-8935
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100503630Medicaid