| Doctor Name: | MS. ROBERTA LYNN FARLEY-ICARD |
| NPI Number: | 1578733689 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPA |
| License Number: | 33823 |
| Business Practice Address: | 6621 Doniphan Dr Ste G Canutillo, TX - 798355005 |
| Business Phone Number: | 9158775100 |
| Business Fax Number: | 9158775107 |
| Mailing Address: | 6621 Doniphan Dr Ste G, CANUTILLO |
| State: | TX |
| Postal Code: | 798355005 |
| Phone Number: | 9158775100 |
| Fax Number: | 9158775107 |
| NPI Enumeration Date: | 03/04/2008 |
| NPI Last Update Date: | 03/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 33823 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |