Provider Demographics
NPI:1972933901
Name:FARISH, EMILY (LAC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:FARISH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26612 BARBER CUT OFF RD NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9585
Mailing Address - Country:US
Mailing Address - Phone:510-599-2862
Mailing Address - Fax:
Practice Address - Street 1:18870 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6233
Practice Address - Country:US
Practice Address - Phone:510-599-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15347171100000X
WAAC60482530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist