Provider Demographics
NPI:1033325139
Name:FREYTAG, VIVIAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:FREYTAG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6338 MYSTIC BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2259
Mailing Address - Country:US
Mailing Address - Phone:713-842-1185
Mailing Address - Fax:713-842-1456
Practice Address - Street 1:6338 MYSTIC BRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2259
Practice Address - Country:US
Practice Address - Phone:713-842-1185
Practice Address - Fax:713-842-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11052101YP2500X
TX001987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist