Provider Demographics
NPI:1891821849
Name:FARABEE, CLIFTON EUGENE (LPC)
Entity type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:EUGENE
Last Name:FARABEE
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 1:344 COUNTY ROAD 1532
Mailing Address - Street 2:
Mailing Address - City:POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75472
Mailing Address - Country:US
Mailing Address - Phone:903-447-3741
Mailing Address - Fax:972-564-4800
Practice Address - Street 1:9199 OLD NACOGDOCHES TRL
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7430
Practice Address - Country:US
Practice Address - Phone:972-564-0455
Practice Address - Fax:972-564-4800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129481OtherNORTHSTAR
TXLP0040148Medicaid