Provider Demographics
NPI:1689056863
Name:FARRAR, TWILA MICHELLE (MED, LPC, RPT, CAS)
Entity Type:Individual
Prefix:
First Name:TWILA
Middle Name:MICHELLE
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MED, LPC, RPT, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4239
Mailing Address - Country:US
Mailing Address - Phone:214-363-4420
Mailing Address - Fax:
Practice Address - Street 1:1033 LONG PRAIRIE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022
Practice Address - Country:US
Practice Address - Phone:214-363-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70471101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health