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General NPI Number Information
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NPI Number | 1144227430
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Entity Type | Organization
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Legal Business Name | LIVING FREE RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 9201 75TH AVENUE NORTH
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City | BROOKLYN PARK
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State | MN
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Zip | 55428
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Country | US
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Telephone | 763-315-7000
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Fax | 763-315-7177
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Provider Business Mailing Address
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Address Line | 9201 75TH AVENUE NORTH
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City | BROOKLYN PARK
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State | MN
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Zip | 55428
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Country | US
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Telephone | 763-315-7000
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Fax | 763-315-7177
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Authorized Official
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Title or Position | PRESIDENT
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Name | TREENA HAASE
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Credential |
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Telephone | 763-315-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 830992-2-CDT
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License Number State | MN
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