MEDICARE: CORY DAVID FARROW MS

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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor	199106	AK

General Provider Information

NPI Number	:	1407479173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY DAVID FARROW MS

Provider Business Mailing Address
First Line	:	341 W TUDOR ROAD SUITE 209
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-6648
Country	:	US
Telephone Number	:	907-331-0576
Fax Number	:	800-511-7484

Provider Business Practice Location Address
First Line	:	341 W TUDOR ROAD SUITE 209
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-6648
Country	:	US
Telephone Number	:	907-331-0576
Fax Number	:	800-511-7484

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

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	06/01/2024

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Directions to “ CORY DAVID FARROW MS” Practice Location

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