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General NPI Number Information
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NPI Number | 1659381051
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Entity Type | Individual
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Provider Name | ELLEN MARY FARR PEULER LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 2100 5TH ST
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City | DAVIS
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State | CA
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Zip | 95618-6591
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Country | US
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Telephone | 916-744-7007
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Fax |
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Provider Business Mailing Address
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Address Line | 8040 W HIDDEN LAKES DR
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City | GRANITE BAY
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State | CA
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Zip | 95746-6947
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Country | US
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Telephone | 916-764-7007
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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 | LCS8324
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License Number State | CA
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