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General NPI Number Information
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NPI Number | 1306474663
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Entity Type | Individual
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Provider Name | TOMMY J FARLEY
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 317 HIGHWAY 13 S
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City | MORTON
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State | MS
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Zip | 39117-3353
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Country | US
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Telephone | 601-732-7012
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Fax | 601-732-7013
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Provider Business Mailing Address
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Address Line | 1515 HOMEWOOD RD APT 310
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City | FOREST
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State | MS
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Zip | 39074-7428
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Country | US
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Telephone | 601-201-7874
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C6810
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License Number State | MS
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