=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215304985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSICA GAYLE MCFARLING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2015
-----------------------------------------------------
Last Update Date | 11/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1727 SWEENEY ST STE 104
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-3834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-929-1762
-----------------------------------------------------
Fax | 833-812-0155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 SE 1ST ST
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47713-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-929-1762
-----------------------------------------------------
Fax | 833-812-0155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MS. JESSICA GAYLE MCFARLING
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 270-929-1762
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------