Provider Demographics
NPI:1659381051
Name:FARR PEULER, ELLEN MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:FARR PEULER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LYN
Other - Middle Name:
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8040 W HIDDEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6947
Mailing Address - Country:US
Mailing Address - Phone:916-764-7007
Mailing Address - Fax:
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6591
Practice Address - Country:US
Practice Address - Phone:916-744-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS8324104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker