Healthcare Provider Details

I. General information

NPI: 1003595836
Provider Name (Legal Business Name): MCKENNA FARREN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 HAINES STE 230
LIBERTY MO
64068-1008
US

IV. Provider business mailing address

3135 NE 59TH TER APT 1
GLADSTONE MO
64119-2132
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-9240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2021024969
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: