Provider Demographics
NPI:1114419116
Name:FREDA, JAMIE S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:S
Last Name:FREDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13407 FROSTDALE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7247
Mailing Address - Country:US
Mailing Address - Phone:512-633-1037
Mailing Address - Fax:
Practice Address - Street 1:1850 ROUND ROCK AVE STE 500
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4023
Practice Address - Country:US
Practice Address - Phone:512-861-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical