Provider Demographics
NPI:1730322991
Name:FARR, CARLA LAKE IV
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:LAKE
Last Name:FARR
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:L
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DOCOTORATE LMFT
Mailing Address - Street 1:1924 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-2811
Mailing Address - Country:US
Mailing Address - Phone:270-443-7553
Mailing Address - Fax:270-443-7553
Practice Address - Street 1:1924 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-2811
Practice Address - Country:US
Practice Address - Phone:270-443-7553
Practice Address - Fax:270-443-7553
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist