1265540652 NPI number — DURELLE L FREEMAN LMHC

Table of content: DURELLE L FREEMAN LMHC (NPI 1265540652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265540652 NPI number — DURELLE L FREEMAN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
DURELLE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265540652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1349
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER CITY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88062-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-388-4497
Provider Business Mailing Address Fax Number:
505-534-1150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 S HUDSON
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-388-4497
Provider Business Practice Location Address Fax Number:
505-534-1150
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0085571 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77021070 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com