MEDICARE: LYNETTE VIRGINIA FARR PH.D., LMFT

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	103TA0700X	Adult Development & Aging Psychologist	MFT000296	GA
2	103TB0200X	Cognitive & Behavioral Psychologist	MFT000296	GA
3	103TC1900X	Counseling Psychologist	MFT000296	GA
4	106H00000X	Marriage & Family Therapist	MFT000296	GA

General Provider Information

NPI Number	:	1023158466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE VIRGINIA FARR PH.D., LMFT

Provider Business Mailing Address
First Line	:	240 CORPORATE CENTER DR
Second Line	:	SUITE D
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7214
Country	:	US
Telephone Number	:	770-507-4124
Fax Number	:	770-507-4124

Provider Business Practice Location Address
First Line	:	240 CORPORATE CENTER DR
Second Line	:	SUITE D
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7214
Country	:	US
Telephone Number	:	770-507-4124
Fax Number	:	770-507-4124

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	06/12/2008

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