Healthcare Provider Details

I. General information

NPI: 1649966425
Provider Name (Legal Business Name): BRIANNE FARREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 3RD AVE
ROCK ISLAND IL
61201-8840
US

IV. Provider business mailing address

3630 PINE RIDGE CT APT 103
MOLINE IL
61265-6557
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2094
  • Fax:
Mailing address:
  • Phone: 608-778-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: