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General NPI Number Information
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NPI Number | 1952808867
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Entity Type | Organization
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Legal Business Name | MY FREEDOM QUEST, INC.
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Dates
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Enumeration Date | 04/07/2018
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Last Update Date | 04/07/2018
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Provider Practice Location Address
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Address Line | 2989 W SR 434 STE 100
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City | LONGWOOD
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State | FL
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Zip | 32779-4898
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Country | US
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Telephone | 407-786-1913
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Fax | 407-960-2636
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Provider Business Mailing Address
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Address Line | 1412 OAK PL APT G
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City | APOPKA
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State | FL
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Zip | 32712-1901
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Country | US
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Telephone | 407-718-6960
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PETER A. BUTKINS
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Credential | PH,D.
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Telephone | 407-718-6960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000755
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License Number State | FL
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