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General NPI Number Information
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NPI Number | 1073237343
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Entity Type | Organization
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Legal Business Name | FREEDOM FIGHTERS THERAPY, LLC
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 12 WEST WENGER ROAD, SUITE S
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City | ENGLEWOOD
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State | OH
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Zip | 45322
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Country | US
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Telephone | 210-405-8981
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Fax | 937-962-6210
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Provider Business Mailing Address
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Address Line | 2186 JACKSON KELLER RD SUITE 2223
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City | SAN ANTONIO
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State | TX
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Zip | 78213
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Country | US
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Telephone | 210-405-8981
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Fax | 937-962-6210
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Authorized Official
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Title or Position | OWNER
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Name | JERALYN R THARP
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Credential | M.EED, LPCC-S, LICDC
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Telephone | 850-889-2880
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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 |
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License Number State |
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