Provider Demographics
NPI:1902424294
Name:FARMER, MADISON ALYSE (MED, PLPC, NCC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ALYSE
Last Name:FARMER
Suffix:
Gender:F
Credentials:MED, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1953
Mailing Address - Country:US
Mailing Address - Phone:504-821-9211
Mailing Address - Fax:504-459-1011
Practice Address - Street 1:2700 S BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1953
Practice Address - Country:US
Practice Address - Phone:504-821-9211
Practice Address - Fax:504-459-1011
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC8117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional