MEDICARE: FREESIA THERAPY COLLECTIVE PLLC

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	106H00000X	Marriage & Family Therapist
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417721473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREESIA THERAPY COLLECTIVE PLLC

Provider Business Mailing Address
First Line	:	6226 213TH AVENUE CT E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-6134
Country	:	US
Telephone Number	:	253-455-0931
Fax Number	:

Provider Business Practice Location Address
First Line	:	6226 213TH AVENUE CT E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-6134
Country	:	US
Telephone Number	:	253-455-0931
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/PARTNER
Name	:	MR. RYAN J LINDSEY
Credential	:	LICSW
Telephone Number	:	253-455-0931

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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