MEDICARE: MRS. MAKEBA Q FARLEY ACIT II, MATS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	TII-5328	IN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MATS-5420	IN

General Provider Information

NPI Number	:	1386591485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAKEBA Q FARLEY ACIT II, MATS

Provider Business Mailing Address
First Line	:	5001 EAST DUNES HIGHWAY
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403
Country	:	US
Telephone Number	:	219-938-4651
Fax Number	:	219-938-9210

Provider Business Practice Location Address
First Line	:	5001 EAST DUNES HIGHWAY
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46403
Country	:	US
Telephone Number	:	219-938-4651
Fax Number	:	219-938-9210

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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