Healthcare Provider Details

I. General information

NPI: 1679598072
Provider Name (Legal Business Name): GARY JOSEPH FREITAS PH.D., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 STONE CREEK DR SUITE 140
CHANHASSEN MN
55317-4605
US

IV. Provider business mailing address

7945 STONE CREEK DR SUITE 140
CHANHASSEN MN
55317-4605
US

V. Phone/Fax

Practice location:
  • Phone: 952-974-3999
  • Fax: 952-974-3780
Mailing address:
  • Phone: 952-974-3999
  • Fax: 952-974-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP4675
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4675
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: