Healthcare Provider Details

I. General information

NPI: 1447088935
Provider Name (Legal Business Name): MIA CLAIRE FREEMAN PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 100A
LAFAYETTE LA
70508-3745
US

IV. Provider business mailing address

1602 W PINHOOK RD STE 100A
LAFAYETTE LA
70508-3745
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-2180
  • Fax:
Mailing address:
  • Phone: 337-981-2180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9358
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: