Provider Demographics
NPI:1205858008
Name:FREEMAN, MARY LUCILLE (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUCILLE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W. ST. MARY BLVD. STE 406
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-233-7867
Mailing Address - Fax:337-235-7199
Practice Address - Street 1:601 W. ST. MARY BLVD. STE 406
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-233-7867
Practice Address - Fax:337-235-7199
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4H346Medicare ID - Type Unspecified