Provider Demographics
NPI:1215284914
Name:FARRIS, BETHANY (MS)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 LISENBY AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2910
Mailing Address - Country:US
Mailing Address - Phone:850-763-7102
Mailing Address - Fax:850-769-0855
Practice Address - Street 1:2121 LISENBY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2910
Practice Address - Country:US
Practice Address - Phone:850-763-7102
Practice Address - Fax:850-769-0855
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health