MEDICARE: MR. MICHAEL FREELS LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH0004377	FL

General Provider Information

NPI Number	:	1407261274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL FREELS LMHC

Provider Business Mailing Address
First Line	:	3081 E COMMERCIAL BLVD
Second Line	:	SUITE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4380
Country	:	US
Telephone Number	:	954-776-6544
Fax Number	:	954-776-5573

Provider Business Practice Location Address
First Line	:	3081 E COMMERCIAL BLVD
Second Line	:	SUITE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4380
Country	:	US
Telephone Number	:	954-776-6544
Fax Number	:	954-776-5573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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