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General NPI Number Information
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NPI Number | 1912145657
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Entity Type | Individual
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Provider Name | ROBERT LESLIE FARRELL M.ED.,NCC
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Gender | Male
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 601 N 7TH ST
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City | WILLIAMS
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State | AZ
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Zip | 86046-1905
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Country | US
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Telephone | 928-635-4428
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Fax | 928-635-1213
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Provider Business Mailing Address
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Address Line | PO BOX 1079 1333 W. PICACHO DR.
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City | ASH FORK
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State | AZ
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Zip | 86320-1079
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Country | US
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Telephone | 928-310-9231
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | AZ
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