Provider Demographics
NPI:1407479173
Name:FARROW, CORY DAVID (MS)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:DAVID
Last Name:FARROW
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W TUDOR ROAD SUITE 209
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6648
Mailing Address - Country:US
Mailing Address - Phone:907-331-0576
Mailing Address - Fax:800-511-7484
Practice Address - Street 1:341 W TUDOR ROAD SUITE 209
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6648
Practice Address - Country:US
Practice Address - Phone:907-331-0576
Practice Address - Fax:800-511-7484
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X
AK199106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health