Provider Demographics
NPI:1760614770
Name:FARLEY, BRYAN EDWARD
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:EDWARD
Last Name:FARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 IRWIN LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5603
Mailing Address - Country:US
Mailing Address - Phone:707-576-7218
Mailing Address - Fax:707-360-1540
Practice Address - Street 1:3164 CONDO CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2557
Practice Address - Country:US
Practice Address - Phone:707-523-2334
Practice Address - Fax:707-360-1540
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health