Provider Demographics
NPI:1861034951
Name:LIESL FARNSWORTH, PHD, LPC
Entity Type:Organization
Organization Name:LIESL FARNSWORTH, PHD, LPC
Other - Org Name:LIESL FARNSWORTH, PHD, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIESL
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:541-388-1261
Mailing Address - Street 1:552 NW SAGINAW AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1120
Mailing Address - Country:US
Mailing Address - Phone:541-388-1261
Mailing Address - Fax:541-306-4577
Practice Address - Street 1:552 NW SAGINAW AVE # 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1120
Practice Address - Country:US
Practice Address - Phone:541-388-1261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty