Healthcare Provider Details

I. General information

NPI: 1144131962
Provider Name (Legal Business Name): JEREMY GORDON FREYE LMFT, M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 ORCHID AVE
WINTER PARK FL
32789-5649
US

IV. Provider business mailing address

4465 DREAMY DAY ST APT 212
APOPKA FL
32712-5395
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-4692
  • Fax:
Mailing address:
  • Phone: 321-243-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: