Provider Demographics
NPI:1073237343
Name:FREEDOM FIGHTERS THERAPY LLC
Entity Type:Organization
Organization Name:FREEDOM FIGHTERS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S LMHC LPC
Authorized Official - Phone:850-889-2880
Mailing Address - Street 1:2744 WALLACE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9172
Mailing Address - Country:US
Mailing Address - Phone:850-889-2880
Mailing Address - Fax:
Practice Address - Street 1:5568 WOODBINE RD # 1027
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8766
Practice Address - Country:US
Practice Address - Phone:850-726-3239
Practice Address - Fax:937-962-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty