Provider Demographics
NPI:1023331501
Name:FARRIS, JAMES DAVIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVIS
Last Name:FARRIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 BRAWNER PKWY
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2352
Mailing Address - Country:US
Mailing Address - Phone:361-834-0328
Mailing Address - Fax:
Practice Address - Street 1:710 BUFFALO ST
Practice Address - Street 2:SUITE808
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-1933
Practice Address - Country:US
Practice Address - Phone:361-888-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical