Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 097.0135198 | VT |
N | 106S00000X | Behavior Technician | ||
N | 175L00000X | Homeopath |
NPI | 1952077604 |
---|---|
Provider Name | Travis Farrar |
First Address | Putnam, CT 06260-1318 |
Second Address | Putnam, CT 06260-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 28/10/2021 |