Doctor Name: | SHANNON FARR |
NPI Number: | 1093056228 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 11211 Se 82nd Ave Suite O Happy Valley, OR - 970867624 |
Business Phone Number: | 5037226200 |
Business Fax Number: | 5037226545 |
Mailing Address: | 2051 Kaen Rd, Suite 367 OREGON CITY |
State: | OR |
Postal Code: | 970454035 |
Phone Number: | 5037425300 |
Fax Number: | 5037425979 |
NPI Enumeration Date: | 03/13/2013 |
NPI Last Update Date: | 03/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |