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General NPI Number Information
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NPI Number | 1649392952
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Entity Type | Individual
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Provider Name | JUSTIN WARD FREEMAN M.A., LCPC
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 N MORGAN ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-1671
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Country | US
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Telephone | 217-259-2366
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Fax | 217-774-9596
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Provider Business Mailing Address
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Address Line | 220 N MORGAN ST
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City | SHELBYVILLE
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State | IL
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Zip | 62565-1671
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Country | US
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Telephone | 217-259-2366
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Fax | 217-774-9596
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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