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General NPI Number Information
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NPI Number | 1134303720
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Entity Type | Individual
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Provider Name | SUSAN RAY FREEMAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 1010 W JASPER DR
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City | KILLEEN
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State | TX
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Zip | 76542-1331
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Country | US
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Telephone | 254-519-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 CASTLE ROCK DR
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City | ROUND ROCK
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State | TX
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Zip | 78681-2267
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Country | US
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Telephone | 512-291-6411
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201200
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License Number State | TX
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