Active NPI
Roberta Lynn Farley-Icard, LPA
- Mental Health Counselor
- Canutillo, TX
National Provider Identifier
1578733689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 33823
- Practice address
- 6621 Doniphan Dr Ste G
Canutillo, TX 79835-5005 - Phone
- (915) 877-5100
- Fax
- (915) 877-5107
- NPI assigned
- Mar 4, 2008
- Last updated
- Mar 4, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 33823 | TX | Primary |
Addresses
Primary practice location
6621 Doniphan Dr Ste G
Canutillo, TX 79835-5005
Mailing address
6621 Doniphan Dr Ste G
Canutillo, TX 79835-5005
Phone (915) 877-5100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VNM30451NI | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33823 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunwest Behavioral Associates PA | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204588800000",
"number": "1578733689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6621 DONIPHAN DR STE G",
"city": "CANUTILLO",
"state": "TX",
"postal_code": "798355005",
"telephone_number": "915-877-5100",
"fax_number": "915-877-5107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6621 DONIPHAN DR STE G",
"city": "CANUTILLO",
"state": "TX",
"postal_code": "798355005",
"telephone_number": "915-877-5100",
"fax_number": "915-877-5107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARLEY-ICARD",
"first_name": "ROBERTA",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "LPA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-04",
"last_updated": "2008-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "33823",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "VNM30451NI",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canutillo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.