Doctor Name: | TERRY THOMAS FARBER |
NPI Number: | 1235430273 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC |
License Number: | 302797 |
Business Practice Address: | 1406 6th Avenue North St. Cloud Hospital- Recovery Plus St. Cloud, MN - 563031901 |
Business Phone Number: | 3202512700 |
Business Fax Number: | |
Mailing Address: | 1900 Centracare Circle # 2475, Centra Care Health Plaza ST. CLOUD |
State: | MN |
Postal Code: | 56303 |
Phone Number: | 3202295199 |
Fax Number: | 3202295109 |
NPI Enumeration Date: | 11/08/2010 |
NPI Last Update Date: | 11/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302797 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |