Provider Demographics
NPI:1790265825
Name:FARRIS, ANNA (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 OXFORD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-1706
Mailing Address - Country:US
Mailing Address - Phone:217-549-1148
Mailing Address - Fax:
Practice Address - Street 1:201 W SPRINGFIELD AVE STE 1005
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4968
Practice Address - Country:US
Practice Address - Phone:491-821-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.01410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional