Provider Demographics
NPI:1184845703
Name:FREDEEN, DOUGLAS (BS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:FREDEEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 S. LOCUST ST.
Mailing Address - Street 2:609-SOUTH
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7164
Mailing Address - Country:US
Mailing Address - Phone:303-845-2817
Mailing Address - Fax:303-825-1711
Practice Address - Street 1:1405 NORTH FEDERAL BLVD.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-504-1505
Practice Address - Fax:303-825-1711
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health