Ellery Farrell
Individual provider Active NPI Mental Health Counselor · Camilla, GA
NPI 1174072540 · NPPES record last updated Sep 27, 2016
Key facts
- NPI
- 1174072540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 198 S Macarthur Dr
Camilla, GA 31730-6370 - Phone
- (229) 336-2247
- NPI assigned
- Sep 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
198 S Macarthur Dr
Camilla, GA 31730-6370
Mailing address
198 S Macarthur Dr
Camilla, GA 31730-6370
Phone (229) 336-2247
Other providers in Camilla, GA
- Casidy Enfinger
- Englewood Health Systems, Inc.
- Charles Edward Evans III
- Eye Partners PC
- Skyler Faircloth
- Lashun Flanders
- Caitlin Fletcher
- Flint River Physical Therapy LLC
- Sherrell Fountain
- Michael D Fowler I
All providers in Camilla, GA · Mental Health Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.