Provider Demographics
NPI:1982079091
Name:IEISHA FARRELL
Entity Type:Organization
Organization Name:IEISHA FARRELL
Other - Org Name:IEISHA FARRELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLO PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:IEISHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-445-8821
Mailing Address - Street 1:708 POINTE CT APT A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6170
Mailing Address - Country:US
Mailing Address - Phone:850-445-8821
Mailing Address - Fax:
Practice Address - Street 1:708 POINTE CT APT A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6170
Practice Address - Country:US
Practice Address - Phone:850-445-8821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1980
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health