Healthcare Provider Details

I. General information

NPI: 1144707290
Provider Name (Legal Business Name): VALERIE MICHELLE FARMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MORA CT APT 101
SCHAUMBURG IL
60193-5138
US

IV. Provider business mailing address

1900 MORA CT APT 101
SCHAUMBURG IL
60193-5138
US

V. Phone/Fax

Practice location:
  • Phone: 847-702-7657
  • Fax:
Mailing address:
  • Phone: 847-702-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.011744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: