Provider Demographics
NPI:1780386193
Name:FARRIS, ELONDON
Entity type:Individual
Prefix:
First Name:ELONDON
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5299 SUNNYSIDE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2226
Mailing Address - Country:US
Mailing Address - Phone:901-701-0122
Mailing Address - Fax:
Practice Address - Street 1:5299 SUNNYSIDE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-2226
Practice Address - Country:US
Practice Address - Phone:901-701-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-19-104092106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician