Provider Demographics
NPI:1063899813
Name:FOOS-FARROW, CHRISTY LEE (LSCSW, LCAC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEE
Last Name:FOOS-FARROW
Suffix:
Gender:F
Credentials:LSCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N B ST
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-4023
Mailing Address - Country:US
Mailing Address - Phone:913-702-6722
Mailing Address - Fax:620-869-9414
Practice Address - Street 1:514 N B ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-4023
Practice Address - Country:US
Practice Address - Phone:913-702-6722
Practice Address - Fax:620-869-9414
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104100000XOtherPROVIDER TAXONOMY CODE