Healthcare Provider Details

I. General information

NPI: 1386290443
Provider Name (Legal Business Name): WADE PETER FREUND LAC, LAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER FREUND

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 E JOYCE BLVD
FAYETTEVILLE AR
72703-4714
US

IV. Provider business mailing address

2153 E JOYCE BLVD
FAYETTEVILLE AR
72703-4714
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-9471
  • Fax:
Mailing address:
  • Phone: 479-575-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberF1906010
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1809135
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: