Provider Demographics
NPI:1831724327
Name:FARMER, CYNTHIA (LADAC II, LPC,MHSP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:LADAC II, LPC,MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 RIVER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8091
Mailing Address - Country:US
Mailing Address - Phone:901-406-8936
Mailing Address - Fax:
Practice Address - Street 1:3256 RIVER VALLEY LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8091
Practice Address - Country:US
Practice Address - Phone:901-406-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003844101YM0800X
TNLADAC0000001109101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty