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General NPI Number Information
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NPI Number | 1780196105
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Entity Type | Organization
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Legal Business Name | FREEDOM'S EDGE
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 3260 WHARTON ST
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City | EAST LANSING
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State | MI
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Zip | 48823-8000
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Country | US
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Telephone | 517-927-5554
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Fax |
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Provider Business Mailing Address
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Address Line | 3260 WHARTON ST
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City | EAST LANSING
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State | MI
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Zip | 48823-8000
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Country | US
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Telephone | 517-927-5554
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW PAUL HELM
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Credential | PHD, LPC
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Telephone | 517-927-5554
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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 | 6401010085
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License Number State | MI
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