Provider Demographics
NPI:1215644257
Name:FARRELL, ZACHARY (LMSW STATE OF MI)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:FARRELL
Suffix:
Gender:M
Credentials:LMSW STATE OF MI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 MEADOW GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9313
Mailing Address - Country:US
Mailing Address - Phone:734-660-6174
Mailing Address - Fax:
Practice Address - Street 1:3521 MEADOW GROVE TRL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9313
Practice Address - Country:US
Practice Address - Phone:734-660-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010976291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical