Healthcare Provider Details

I. General information

NPI: 1306407887
Provider Name (Legal Business Name): FREEDOM COUNSELING, COACHING, AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 KELLEY LN
NEWARK OH
43055-8057
US

IV. Provider business mailing address

PO BOX 4381
NEWARK OH
43058-4381
US

V. Phone/Fax

Practice location:
  • Phone: 740-641-7222
  • Fax:
Mailing address:
  • Phone: 740-641-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLEY BECKETT
Title or Position: OWNER
Credential: LPC
Phone: 740-641-7222