Provider Demographics
NPI:1659427920
Name:FARRELL, CAROLYN ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:FARRELL-SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M FT
Mailing Address - Street 1:6216 B HIGHWAY 9
Mailing Address - Street 2:SUITE G
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018
Mailing Address - Country:US
Mailing Address - Phone:831-325-6647
Mailing Address - Fax:530-566-1380
Practice Address - Street 1:6216 B HIGHWAY
Practice Address - Street 2:SUITE G
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-4058
Practice Address - Country:US
Practice Address - Phone:530-321-8545
Practice Address - Fax:530-566-1380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist