Healthcare Provider Details

I. General information

NPI: 1033182001
Provider Name (Legal Business Name): JONATHAN M FARRELL-HIGGINS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 SW BURLINGAME RD
TOPEKA KS
66611-2051
US

IV. Provider business mailing address

3649 SW BURLINGAME RD
TOPEKA KS
66611-2051
US

V. Phone/Fax

Practice location:
  • Phone: 785-266-6751
  • Fax: 785-266-4533
Mailing address:
  • Phone: 785-266-6751
  • Fax: 785-266-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number740
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: