Provider Demographics
NPI:1508398322
Name:FARRAR, MONICA D (PCA, NCC, MA)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:D
Last Name:FARRAR
Suffix:
Gender:F
Credentials:PCA, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6599 SW 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-7258
Mailing Address - Country:US
Mailing Address - Phone:971-235-5136
Mailing Address - Fax:
Practice Address - Street 1:5741 NE GLISAN ST STE 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3793
Practice Address - Country:US
Practice Address - Phone:971-235-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health