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General NPI Number Information
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NPI Number | 1366046401
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Entity Type | Individual
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Provider Name | TROY W FARRIS LPC
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 11201 OLD HIGHWAY 49
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City | GULFPORT
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State | MS
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Zip | 39503-4143
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Country | US
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Telephone | 228-324-4580
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Fax |
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Provider Business Mailing Address
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Address Line | 17608 ROBINSON RD
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City | GULFPORT
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State | MS
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Zip | 39503-7759
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Country | US
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Telephone | 228-324-4580
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2354
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License Number State | MS
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