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Individual

MR. JODY DEAN FARRA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA LPE LPC

Contact information

Practice address
6 SIXTH ST, CENTRAL BUILDING SUITE 205, BRISTOL, TN 37620
(423) 968-2225
(423) 968-2225
Mailing address
1242 HIGHRIDGE DRIVE, KINGSPORT, TN 37664
(423) 323-9289
(423) 968-2225

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC000282
TN
101YM0800X
Mental Health Counselor
PE000531
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
TPIN 13037341
FED GOVT TRADE PARTNER ID
Enumeration date
08/02/2006
Last updated
07/08/2007
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