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1053298935 NPI number — RYAN FREESE

NPI Number: 1053298935
Health Care Provider/Practitioner: RYAN FREESE

Information about “1053298935” NPI (RYAN FREESE) exists in 1053298935 in HTML format HTML  |  1053298935 in plain Text format TXT  |  1053298935 in PDF (Portable Document Format) PDF  |  1053298935 in an XML format XML  formats.

NPI Number : 1053298935 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053298935",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FREESE",
    "FirstName": "RYAN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "601 W NIFONG BLVD STE 1D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65203-6804",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-228-6702",
    "MailingAddressFaxNumber": "573-228-6703",
    "FirstLinePracticeLocationAddress": "601 W NIFONG BLVD STE 1D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65203-6804",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-228-6702",
    "PracticeLocationAddressFaxNumber": "573-228-6703",
    "EnumerationDate": "08/20/2025",
    "LastUpdateDate": "08/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "2020005138",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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