Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TH0100X | Health Service | 20042799A | IN |
NPI | 1376774190 |
---|---|
Provider Name | Anita Gail Farrell |
First Address | Terre Haute, IN 47803-2239 |
Second Address | Terre Haute, IN 47803-2239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 16/04/2015 |