Provider Demographics
NPI:1063948941
Name:FARLEY, PAUL (LPC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:FARLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 MELCOMBE CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3460
Mailing Address - Country:US
Mailing Address - Phone:517-260-9587
Mailing Address - Fax:
Practice Address - Street 1:600 N BROAD ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2132
Practice Address - Country:US
Practice Address - Phone:517-260-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015774101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor