MEDICARE: MARY ELIZABETH FREEMAN M.S.

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	106H00000X	Marriage & Family Therapist	MFC31461	CA
2	106H00000X	Marriage & Family Therapist	792	CO

General Provider Information

NPI Number	:	1982692992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH FREEMAN M.S.

Provider Business Mailing Address
First Line	:	503 REMINGTON ST
Second Line	:	SUITE 105
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3074
Country	:	US
Telephone Number	:	970-266-1259
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 REMINGTON ST
Second Line	:	SUITE 105
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3074
Country	:	US
Telephone Number	:	970-266-1259
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/22/2007

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