Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003284548 |
---|---|
Provider Name | Elbert Farmer |
First Address | Mesa, AZ 85210-1310 |
Second Address | Mesa, AZ 85210-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2015 |
Last Update Date | 14/09/2015 |