Provider Demographics
NPI:1164929592
Name:FRIELS, TORE' MONEA
Entity Type:Individual
Prefix:
First Name:TORE'
Middle Name:MONEA
Last Name:FRIELS
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 1:1140 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-1545
Mailing Address - Country:US
Mailing Address - Phone:318-346-8001
Mailing Address - Fax:
Practice Address - Street 1:1140 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1545
Practice Address - Country:US
Practice Address - Phone:318-346-8001
Practice Address - Fax:318-346-8005
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1544761Medicaid
LA1679507412OtherNPI