Healthcare Provider Details

I. General information

NPI: 1992648687
Provider Name (Legal Business Name): JENNIFER ELLEN FARAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 DIXIE HWY
SHIVELY KY
40216-4147
US

IV. Provider business mailing address

3930 DIXIE HWY
LOUISVILLE KY
40216-4147
US

V. Phone/Fax

Practice location:
  • Phone: 502-553-8923
  • Fax:
Mailing address:
  • Phone: 502-553-8923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number305357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: