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General NPI Number Information
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NPI Number | 1083838361
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Entity Type | Organization
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Legal Business Name | FREEDOM COUNSELING CENTER INC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 1901 NILES AVE SUITE 102
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1615
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Country | US
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Telephone | 269-982-7200
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Fax | 269-982-0202
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Provider Business Mailing Address
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Address Line | 1901 NILES AVE SUITE 102
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1615
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Country | US
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Telephone | 269-982-7200
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Fax | 269-982-0202
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY W. MCVAY
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Credential |
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Telephone | 269-982-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301010863
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License Number State | MI
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