Provider Demographics
NPI:1174941157
Name:FARRELL, DEBRA J (PHD, LPC, CCMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:J
Last Name:FARRELL
Suffix:
Gender:F
Credentials:PHD, LPC, CCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S CREYTS RD STE B
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8266
Mailing Address - Country:US
Mailing Address - Phone:517-285-0527
Mailing Address - Fax:
Practice Address - Street 1:612 S CREYTS RD STE B
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8266
Practice Address - Country:US
Practice Address - Phone:517-285-0527
Practice Address - Fax:517-220-4694
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC02376101YA0400X
MI318674101YM0800X
MI00049518225C00000X
MI5201000678225X00000X
MI6401012447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist