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General NPI Number Information
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NPI Number | 1003691114
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Entity Type | Individual
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Provider Name | SAMMY TRAVIS FRESHNER JR. M.ED, MAC, LPCRA
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Gender | Male
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1584 NE 8TH ST STE 200
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City | GRESHAM
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State | OR
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Zip | 97030-5746
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Country | US
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Telephone | 503-890-8773
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 NE ALTON CT
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City | FAIRVIEW
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State | OR
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Zip | 97024-7736
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Country | US
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Telephone | 503-209-3995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R5274
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License Number State | OR
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