Provider Demographics
NPI:1750495065
Name:FARRAR, LAURA KATHLEEN (MSED LCPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHLEEN
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MSED LCPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KATHLEEN
Other - Last Name:AHRENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:287 LANDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3611
Mailing Address - Country:US
Mailing Address - Phone:630-334-9146
Mailing Address - Fax:
Practice Address - Street 1:287 LANDFIELD RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3611
Practice Address - Country:US
Practice Address - Phone:630-334-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002225381OtherBLUE CROSS BLUE SHIELD