Healthcare Provider Details

I. General information

NPI: 1245796440
Provider Name (Legal Business Name): JOSHUA EDWARD FREEMAN LCSW
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: IRENE FREEMAN

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N BELCREST AVE STE A
SPRINGFIELD MO
65802-6287
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 417-413-4676
  • Fax: 417-763-3308
Mailing address:
  • Phone: 417-761-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020039618
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: