MEDICARE: MR. WOODSON H FARRAR LCDC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	79370	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	14343	TX

General Provider Information

NPI Number	:	1013552298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WOODSON H FARRAR LCDC, LPC

Provider Business Mailing Address
First Line	:	15342 PARK ROW
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-2887
Country	:	US
Telephone Number	:	832-830-4821
Fax Number	:

Provider Business Practice Location Address
First Line	:	15342 PARK ROW
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-2887
Country	:	US
Telephone Number	:	832-830-4821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	01/30/2024

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