Healthcare Provider Details

I. General information

NPI: 1023233277
Provider Name (Legal Business Name): MICHAEL LEE FREYTAG MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE SUITE 400
JACKSON MI
49202-2179
US

IV. Provider business mailing address

214 N DURAND ST
JACKSON MI
49202-4119
US

V. Phone/Fax

Practice location:
  • Phone: 517-474-3793
  • Fax: 517-796-4561
Mailing address:
  • Phone: 517-474-3793
  • Fax: 517-796-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401000462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: