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General NPI Number Information
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NPI Number | 1376197822
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Entity Type | Individual
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Provider Name | KETURAH JOLENE FARMER LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 504 W MAIN ST
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City | WEST PLAINS
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State | MO
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Zip | 65775-2732
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Country | US
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Telephone | 417-252-0846
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1475
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City | WEST PLAINS
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State | MO
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Zip | 65775-1475
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Country | US
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Telephone | 417-815-4769
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2019029468
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License Number State | MO
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