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General NPI Number Information
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NPI Number | 1811762982
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Entity Type | Organization
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Legal Business Name | FREEDOM FORMULA RX, LLC
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 14405 WALTERS RD STE 1016
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City | HOUSTON
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State | TX
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Zip | 77014-1493
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Country | US
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Telephone | 832-559-7520
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Fax | 832-559-7284
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Provider Business Mailing Address
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Address Line | 18806 CENTERRA SPRINGS DR
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City | CYPRESS
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State | TX
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Zip | 77429-7598
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Country | US
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Telephone | 409-225-6044
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. ABBI JONES PRUITT
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Credential | NCC, LPC-S, LMSW
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Telephone | 409-225-6044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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