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General NPI Number Information
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NPI Number | 1417432790
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Entity Type | Individual
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Provider Name | TAYLOR KERSEY FREEMAN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 775 TANNER CT
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City | MERCED
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State | CA
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Zip | 95341-8905
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Country | US
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Telephone | 209-913-7282
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 11TH ST
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City | MODESTO
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State | CA
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Zip | 95354-0748
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Country | US
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Telephone | 120-928-4097
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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