Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053438549 |
---|---|
Provider Name | John E Farrell |
First Address | Santa Fe Springs, CA 90670-3681 |
Second Address | Santa Fe Springs, CA 90670-3681 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 01/06/2010 |