MEDICARE: FARRAH NOLAN CRC, RMHI

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	IMH11435	FL

General Provider Information

NPI Number	:	1295117158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH NOLAN CRC, RMHI

Provider Business Mailing Address
First Line	:	2207 GLADYS ST
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-1332
Country	:	US
Telephone Number	:	727-417-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	2207 GLADYS ST
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-1332
Country	:	US
Telephone Number	:	727-417-0271
Fax Number	:

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	06/26/2015

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