Healthcare Provider Details

I. General information

NPI: 1497183776
Provider Name (Legal Business Name): THELMA FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 S LEWIS AVE
TULSA OK
74105-7104
US

IV. Provider business mailing address

2922 OKLAHOMA ST
MUSKOGEE OK
74401-2746
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-4556
  • Fax:
Mailing address:
  • Phone: 918-816-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: