Healthcare Provider Details

I. General information

NPI: 1982103545
Provider Name (Legal Business Name): DANIEL FARRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 S 7TH ST
IRONTON OH
45638-2538
US

IV. Provider business mailing address

122 OLIVE ST
HUNTINGTON WV
25705-1517
US

V. Phone/Fax

Practice location:
  • Phone: 740-550-5228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.168267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: