Healthcare Provider Details

I. General information

NPI: 1831582089
Provider Name (Legal Business Name): FREEDOM THERAPY AND RECOVERY SERVICES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 DOGWOOD DR
KOKOMO IN
46902-5737
US

IV. Provider business mailing address

1810 DOGWOOD DR
KOKOMO IN
46902-5737
US

V. Phone/Fax

Practice location:
  • Phone: 260-274-0230
  • Fax: 260-274-1500
Mailing address:
  • Phone: 260-274-0230
  • Fax: 260-274-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name: LORI A ROBERTSON
Title or Position: PARTNER, THERAPIST
Credential: LCSW, LCAC
Phone: 260-274-0230