Basic Information
| Provider Information | |||||||||
| NPI: | 1902424294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | MADISON | ||||||||
| MiddleName: | ALYSE | ||||||||
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| Credential: | M.ED., PLPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701251953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048219211 | ||||||||
| FaxNumber: | 5044591011 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701251953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048219211 | ||||||||
| FaxNumber: | 5044591011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2020 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PLC8117 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.