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General NPI Number Information
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NPI Number | 1285641340
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Entity Type | Individual
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Provider Name | JODY DEAN FARRA MA LPE LPC
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6 SIXTH ST CENTRAL BUILDING SUITE 205
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City | BRISTOL
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State | TN
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Zip | 37620
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Country | US
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Telephone | 423-968-2225
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Fax | 423-968-2225
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Provider Business Mailing Address
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Address Line | 1242 HIGHRIDGE DRIVE
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City | KINGSPORT
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State | TN
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Zip | 37664
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Country | US
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Telephone | 423-323-9289
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Fax | 423-968-2225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PE000531
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC000282
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License Number State | TN
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