MEDICARE: FRIEDEL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7948282406	OTHER		SELF PAY

General Provider Information

NPI Number	:	1023603750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIEDEL, LLC

Provider Business Mailing Address
First Line	:	3302 2ND AVE N
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2005
Country	:	US
Telephone Number	:	406-794-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	3302 2ND AVE N
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2005
Country	:	US
Telephone Number	:	406-794-8282
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. RICHARD A FRIEDEL
Credential	:	DM
Telephone Number	:	406-794-8282

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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