Provider Demographics
NPI:1629488556
Name:FARRAY, SUSY
Entity Type:Individual
Prefix:
First Name:SUSY
Middle Name:
Last Name:FARRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 ORANGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-0604
Mailing Address - Country:US
Mailing Address - Phone:702-525-6826
Mailing Address - Fax:
Practice Address - Street 1:2235 E FLAMINGO RD STE 404
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5197
Practice Address - Country:US
Practice Address - Phone:702-685-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation