Healthcare Provider Details

I. General information

NPI: 1235953589
Provider Name (Legal Business Name): ALEXANDRA MARIE FREEMAN MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 STONEWALL ST
GREENVILLE TX
75401-3343
US

IV. Provider business mailing address

2105 STONEWALL ST.
GREENVILLE TX
75401
US

V. Phone/Fax

Practice location:
  • Phone: 631-804-2889
  • Fax:
Mailing address:
  • Phone: 631-804-2889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: