Provider Demographics
NPI:1114474384
Name:FREIMUTH, CARRIE MELISSA
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MELISSA
Last Name:FREIMUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 QUEEN PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-4485
Mailing Address - Country:US
Mailing Address - Phone:209-417-9253
Mailing Address - Fax:
Practice Address - Street 1:1525 QUEEN PALM AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4485
Practice Address - Country:US
Practice Address - Phone:209-417-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11622532103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst