Provider Demographics
NPI:1942549910
Name:BURGESS, FARRAH N (LPCC)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:N
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-1552
Mailing Address - Country:US
Mailing Address - Phone:270-285-9023
Mailing Address - Fax:270-285-9037
Practice Address - Street 1:111 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437
Practice Address - Country:US
Practice Address - Phone:270-836-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 171M00000X, 101YM0800X, 101YP2500X
104859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty