Provider Demographics
NPI:1952672594
Name:FARRAR, FRED MATTHEW (LPC , NCC)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:MATTHEW
Last Name:FARRAR
Suffix:
Gender:M
Credentials: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:PO BOX 4078
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-0082
Mailing Address - Country:US
Mailing Address - Phone:706-837-0045
Mailing Address - Fax:706-837-0035
Practice Address - Street 1:98 GORDON COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5735
Practice Address - Country:US
Practice Address - Phone:706-837-0045
Practice Address - Fax:706-837-0035
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA271261101YA0400X
101YM0800X
GA005914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health