Provider Demographics
NPI:1285268797
Name:FARNSWORTH, MICHELA (LICSW)
Entity type:Individual
Prefix:
First Name:MICHELA
Middle Name:
Last Name:FARNSWORTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FRANKLIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3356
Mailing Address - Country:US
Mailing Address - Phone:360-489-6195
Mailing Address - Fax:
Practice Address - Street 1:800 FRANKLIN ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3356
Practice Address - Country:US
Practice Address - Phone:360-489-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60726027101YA0400X
WALW610165701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)