1245298561 NPI number — MS. GEORGANN R FREASIER LCSW

Table of content: MS. GEORGANN R FREASIER LCSW (NPI 1245298561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245298561 NPI number — MS. GEORGANN R FREASIER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREASIER
Provider First Name:
GEORGANN
Provider Middle Name:
R
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1245298561
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:
1024 N ARTHUR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72207-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-661-1633
Provider Business Mailing Address Fax Number:
501-280-0204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 N FILLMORE ST
Provider Second Line Business Practice Location Address:
FILLMORE PLACE
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-3322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-661-1557
Provider Business Practice Location Address Fax Number:
501-661-1654
Provider Enumeration Date:
05/03/2006

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: 1041C0700X , with the licence number:  548-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37814937 . This is a "UNITED BAHAVORIAL HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 4499093 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 170718 . This is a "VALUE OPTIONS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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