Healthcare Provider Details

I. General information

NPI: 1649802281
Provider Name (Legal Business Name): FARRAR AND ASSOCIATES MENTAL HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 TRI PARK WAY
APPLETON WI
54914-1658
US

IV. Provider business mailing address

16 TRI PARK WAY
APPLETON WI
54914-1658
US

V. Phone/Fax

Practice location:
  • Phone: 920-841-8326
  • Fax:
Mailing address:
  • Phone: 920-841-8326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TASHA FARRAR
Title or Position: PRESIDENT
Credential: MD
Phone: 920-841-8326