Basic Information
| Provider Information | |||||||||
| NPI: | 1245688639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARRELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 CIMARRON PLAZA | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740752600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053722202 | ||||||||
| FaxNumber: | 4053722237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1624 CIMARRON PLAZA | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740752600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053722202 | ||||||||
| FaxNumber: | 4053722237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.