Provider Demographics
NPI:1184203937
Name:FREEMAN, CORTLANDT GRANT (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CORTLANDT
Middle Name:GRANT
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 PERRIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2669
Mailing Address - Country:US
Mailing Address - Phone:765-237-9561
Mailing Address - Fax:
Practice Address - Street 1:649 PERRIN AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2669
Practice Address - Country:US
Practice Address - Phone:765-237-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004672A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty