Healthcare Provider Details

I. General information

NPI: 1235096132
Provider Name (Legal Business Name): STEPHANIE JEAN FREISE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6156 RALSTON ST
FREDERICK CO
80530-4822
US

IV. Provider business mailing address

6156 RALSTON ST
FREDERICK CO
80530-4822
US

V. Phone/Fax

Practice location:
  • Phone: 970-270-2020
  • Fax:
Mailing address:
  • Phone: 970-270-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0998673
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0021877
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: