Healthcare Provider Details

I. General information

NPI: 1114115144
Provider Name (Legal Business Name): MELISSA PRICE FARRAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 POPLAR AVE 27TH FLOOR
MEMPHIS TN
38137-4000
US

IV. Provider business mailing address

5100 POPLAR AVE SUITE 2700 PMB 108
MEMPHIS TN
38137-4000
US

V. Phone/Fax

Practice location:
  • Phone: 901-491-6966
  • Fax:
Mailing address:
  • Phone: 901-491-6966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4789
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: