MEDICARE: ERIC SCOTT FREEMAN LCMHC

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	101YM0800X	Mental Health Counselor	90108276004	UT

General Provider Information

NPI Number	:	1548748981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC SCOTT FREEMAN LCMHC

Provider Business Mailing Address
First Line	:	3655 N SUMMER WAY
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-4283
Country	:	US
Telephone Number	:	801-623-8713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 W STATE RD STE 206
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-5041
Country	:	US
Telephone Number	:	801-623-8713
Fax Number	:

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

Provider Enumeration Date	:	07/28/2018
Last Update Date	:	07/28/2018

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