Healthcare Provider Details

I. General information

NPI: 1508282831
Provider Name (Legal Business Name): CHELSEA FARRAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 MAIN ST
CONWAY AR
72032-5426
US

IV. Provider business mailing address

1014 MAIN ST
CONWAY AR
72032-5426
US

V. Phone/Fax

Practice location:
  • Phone: 501-336-0511
  • Fax: 501-336-4037
Mailing address:
  • Phone: 501-336-0511
  • Fax: 501-336-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1403040
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: