1164686416 NPI number — MRS. LISA GARRETT FARHAT M.ED, LPC, RPT

Table of content: MRS. LISA GARRETT FARHAT M.ED, LPC, RPT (NPI 1164686416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164686416 NPI number — MRS. LISA GARRETT FARHAT M.ED, LPC, RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARHAT
Provider First Name:
LISA
Provider Middle Name:
GARRETT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LPC, RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRETT
Provider Other First Name:
LISA
Provider Other Middle Name:
REE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC-1
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164686416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 ABBY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATHERFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76086-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-229-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 INTERNATIONAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76109-4892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-229-7900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  20098 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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