Provider Demographics
NPI:1750495065
Name:FARRAR, LAURA KATHLEEN (MSED LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHLEEN
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MSED LCPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KATHLEEN
Other - Last Name:AHRENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 N. RIVER ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-718-0717
Mailing Address - Fax:630-718-0747
Practice Address - Street 1:640 N. RIVER ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-718-0717
Practice Address - Fax:630-718-0747
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002225381OtherBLUE CROSS BLUE SHIELD