Provider Demographics
NPI:1649835943
Name:FARVOUR, LISA ARLENE (LMHC, CDP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ARLENE
Last Name:FARVOUR
Suffix:
Gender:F
Credentials:LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 HEADQUARTERS RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9350
Mailing Address - Country:US
Mailing Address - Phone:360-751-4195
Mailing Address - Fax:
Practice Address - Street 1:57 W MAIN ST STE 260
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4815
Practice Address - Country:US
Practice Address - Phone:360-751-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60252270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60730101OtherDEPARTMENT OF HEALTH
WALH60252270OtherDEPARTMENT OF HEALTH