Provider Demographics
NPI:1689358558
Name:FARNSWORTH, ELYSE (LP)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 LAMETTI LN
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3676
Mailing Address - Country:US
Mailing Address - Phone:612-203-5063
Mailing Address - Fax:
Practice Address - Street 1:1487 LAMETTI LN
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3676
Practice Address - Country:US
Practice Address - Phone:612-203-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist