Healthcare Provider Details

I. General information

NPI: 1194653840
Provider Name (Legal Business Name): KASEY J FRESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 E BASELINE RD
MESA AZ
85206-4412
US

IV. Provider business mailing address

21412 E BONANZA WAY
QUEEN CREEK AZ
85142-3290
US

V. Phone/Fax

Practice location:
  • Phone: 480-482-1838
  • Fax:
Mailing address:
  • Phone: 678-982-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24853
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: