Provider Demographics
NPI:1962612614
Name:LYNETTE V. FARR, PH.D., LMFT, INC.
Entity type:Organization
Organization Name:LYNETTE V. FARR, PH.D., LMFT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:770-507-4124
Mailing Address - Street 1:1129 HOSPITAL DR
Mailing Address - Street 2:SUITE 7-G
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6393
Mailing Address - Country:US
Mailing Address - Phone:770-507-4124
Mailing Address - Fax:770-507-4124
Practice Address - Street 1:1129 HOSPITAL DR
Practice Address - Street 2:SUITE 7-G
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6393
Practice Address - Country:US
Practice Address - Phone:770-507-4124
Practice Address - Fax:770-507-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000296103TA0700X, 103TB0200X, 103TC1900X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicare UPIN