MEDICARE: MR. JOHN D. FREEMAN JR. LPC

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	101Y00000X	Counselor	65178	TX

General Provider Information

NPI Number	:	1417315128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN D. FREEMAN JR. LPC

Provider Business Mailing Address
First Line	:	1475 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4109
Country	:	US
Telephone Number	:	214-522-4640
Fax Number	:	214-522-4650

Provider Business Practice Location Address
First Line	:	1475 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4109
Country	:	US
Telephone Number	:	214-522-4640
Fax Number	:	214-522-4650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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