=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669510491
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN M FREEMAN LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5600 MONROE ST
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-2740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-885-1910
-----------------------------------------------------
Fax | 419-885-5060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3425 PELHAM RD
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43606-2471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-340-7735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | E7809
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------