Provider Demographics
NPI:1760658850
Name:EDWARD STEPHEN FARRELL, LPC
Entity Type:Organization
Organization Name:EDWARD STEPHEN FARRELL, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-887-0822
Mailing Address - Street 1:101 N SHORELINE BLVD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2824
Mailing Address - Country:US
Mailing Address - Phone:361-887-0822
Mailing Address - Fax:
Practice Address - Street 1:101 N SHORELINE BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2824
Practice Address - Country:US
Practice Address - Phone:361-887-0822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty