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General NPI Number Information
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NPI Number | 1588120752
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Entity Type | Individual
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Provider Name | CAROLYN STACEY FARRIS TLPC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 809 S PATTON RD
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City | GREAT BEND
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State | KS
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Zip | 67530-4625
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1223
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City | GREAT BEND
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State | KS
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Zip | 67530-1223
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Country | US
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Telephone | 620-796-2206
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3375
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License Number State | KS
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