Provider Demographics
NPI:1689429185
Name:MARSHALL, FARAH E (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:E
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3811
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-3811
Mailing Address - Country:US
Mailing Address - Phone:310-465-5312
Mailing Address - Fax:
Practice Address - Street 1:1335 GUSDORF RD STE E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5227
Practice Address - Country:US
Practice Address - Phone:505-448-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42828342Medicaid