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NPI Code Detail

MEDICARE: ELIZABETH ANN FARRIS LCSW, LAC

MEDICARE: ELIZABETH ANN FARRIS LCSW, LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2104100000XSocial WorkerLSW.0009920946CO
3101YA0400XAddiction (Substance Use Disorder) CounselorACD.0001430CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114422136
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ANN FARRIS LCSW, LAC
Provider Business Mailing Address
First Line : 5455 N UNION BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-2077
Country : US
Telephone Number : 719-308-5450
Fax Number :
Provider Business Practice Location Address
First Line : 5455 N UNION BLVD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-2077
Country : US
Telephone Number : 719-308-5450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2018
Last Update Date : 10/02/2024

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