Healthcare Provider Details

I. General information

NPI: 1538220744
Provider Name (Legal Business Name): JEFFREY L FREIDEN LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 BRANTFORD AVE
MEMPHIS TN
38120-2440
US

IV. Provider business mailing address

PO BOX 771139
MEMPHIS TN
38177-1139
US

V. Phone/Fax

Practice location:
  • Phone: 901-289-8294
  • Fax: 901-682-8697
Mailing address:
  • Phone: 901-289-8294
  • Fax: 901-682-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number00856
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00856
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00856
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00856
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: