Provider Demographics
NPI:1851731020
Name:FARLEY, TASIA K (LMLP)
Entity Type:Individual
Prefix:
First Name:TASIA
Middle Name:K
Last Name:FARLEY
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:TASIA
Other - Middle Name:K
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-8125
Mailing Address - Country:US
Mailing Address - Phone:620-326-7448
Mailing Address - Fax:620-326-6662
Practice Address - Street 1:1601 W 16TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-8125
Practice Address - Country:US
Practice Address - Phone:620-326-7448
Practice Address - Fax:620-326-6662
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2473103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201076600AMedicaid