MEDICARE: FREELS MENTAL HEALTH GROUP, PA

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	:	1568486140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREELS MENTAL HEALTH GROUP, PA

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

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL FREELS
Credential	:	LMHC
Telephone Number	:	954-776-6544

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/24/2012

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