Provider Demographics
NPI:1548625700
Name:FARRELL COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:FARRELL COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-597-3186
Mailing Address - Street 1:3812 WATSON DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2031
Mailing Address - Country:US
Mailing Address - Phone:727-597-3186
Mailing Address - Fax:888-289-2159
Practice Address - Street 1:7620 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-1108
Practice Address - Country:US
Practice Address - Phone:727-848-0185
Practice Address - Fax:888-289-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10652251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011713700Medicaid
FLFX136AMedicare PIN