Provider Demographics
NPI:1144557570
Name:FARRELL, ELLEN (LPC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WILLOW POINT CIR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3925
Mailing Address - Country:US
Mailing Address - Phone:912-247-4263
Mailing Address - Fax:
Practice Address - Street 1:415 BONAVENTURE RD
Practice Address - Street 2:
Practice Address - City:THUNDERBOLT
Practice Address - State:GA
Practice Address - Zip Code:31404-3299
Practice Address - Country:US
Practice Address - Phone:912-247-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional