Provider Demographics
NPI:1003353491
Name:FREELING, BETHANY JOY (LM)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:FREELING
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5971 RALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1105
Mailing Address - Country:US
Mailing Address - Phone:510-299-1983
Mailing Address - Fax:
Practice Address - Street 1:5971 RALSTON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1105
Practice Address - Country:US
Practice Address - Phone:510-299-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM245176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife