Healthcare Provider Details

I. General information

NPI: 1184845703
Provider Name (Legal Business Name): DOUGLAS FREDEEN B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 NORTH FEDERAL BLVD.
DENVER CO
80204
US

IV. Provider business mailing address

2880 S. LOCUST ST. 609-SOUTH
DENVER CO
80222-7164
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-1505
  • Fax: 303-825-1711
Mailing address:
  • Phone: 303-845-2817
  • Fax: 303-825-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: