Provider Demographics
NPI:1952845182
Name:FARNQUIST, KATIE (MA COUNSELING, LLPC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:FARNQUIST
Suffix:
Gender:F
Credentials:MA COUNSELING, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 BALDWIN ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49426
Mailing Address - Country:US
Mailing Address - Phone:616-296-2130
Mailing Address - Fax:
Practice Address - Street 1:1388 BALDWIN ST.
Practice Address - Street 2:SUITE A
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49426
Practice Address - Country:US
Practice Address - Phone:616-296-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional