Provider Demographics
NPI:1881375947
Name:WINZENBURG, ELISSA LEIGH FARRAR (MS, NCC, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:LEIGH FARRAR
Last Name:WINZENBURG
Suffix:
Gender:F
Credentials:MS, NCC, LPC-MHSP
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:LEIGH
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3350 WHITE WING RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-7403
Mailing Address - Country:US
Mailing Address - Phone:615-428-5909
Mailing Address - Fax:
Practice Address - Street 1:10414 JACKSON OAKS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0703
Practice Address - Country:US
Practice Address - Phone:615-428-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1463213101YM0800X
TN6825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health