Provider Demographics
NPI:1619203056
Name:FARNUM, WILLIAM LESLIE (MSSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LESLIE
Last Name:FARNUM
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4616
Mailing Address - Country:US
Mailing Address - Phone:903-534-5171
Mailing Address - Fax:903-534-5171
Practice Address - Street 1:1901 VETERANS MEMORIAL DR.
Practice Address - Street 2:VETERANS ADMINISTRATION
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-0005
Practice Address - Country:US
Practice Address - Phone:903-723-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0701101YP2500X
TX152171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional