Provider Demographics
NPI:1164903472
Name:FREEZE, BROOKE (LAMFT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FREEZE
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:FIELDING
Mailing Address - State:UT
Mailing Address - Zip Code:84311-0192
Mailing Address - Country:US
Mailing Address - Phone:435-279-4501
Mailing Address - Fax:
Practice Address - Street 1:18 N 200 E STE 406
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-1442
Practice Address - Country:US
Practice Address - Phone:435-279-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10851664-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist