MEDICARE: MR. DANIEL E FARRIS SR. 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	101YP2500X	Professional Counselor	13518	TX

General Provider Information

NPI Number	:	1871545343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL E FARRIS SR. LPC

Provider Business Mailing Address
First Line	:	1701 RIVER RUN
Second Line	:	305
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	972-333-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 RIVER RUN
Second Line	:	305
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	972-333-0960
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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