MEDICARE: MR. MICAH FREEMAN M.S.,M.A.T.

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	6093590	OR

General Provider Information

NPI Number	:	1487189288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICAH FREEMAN M.S.,M.A.T.

Provider Business Mailing Address
First Line	:	1906 SW MADISON ST
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97205-1759
Country	:	US
Telephone Number	:	971-344-4017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 SW MADISON ST
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97205-1759
Country	:	US
Telephone Number	:	971-344-4017
Fax Number	:

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

Provider Enumeration Date	:	04/29/2017
Last Update Date	:	04/29/2017

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