Provider Demographics
NPI:1518380427
Name:FARRELL, EDWARD STEPHEN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEPHEN
Last Name:FARRELL
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:101 N SHORELINE BLVD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2341
Mailing Address - Country:US
Mailing Address - Phone:361-887-0822
Mailing Address - Fax:
Practice Address - Street 1:101 N SHORELINE BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2341
Practice Address - Country:US
Practice Address - Phone:361-887-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX702101YP2500X
TX1849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist