=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144551573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNETTE A FREEL MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2010
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 PLAZA DR. SUITE D
-----------------------------------------------------
City | BEREA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-200-1990
-----------------------------------------------------
Fax | 859-986-0544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 554
-----------------------------------------------------
City | BEREA
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-200-1990
-----------------------------------------------------
Fax | 859-986-0544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0645
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------