Provider Demographics
NPI:1275018335
Name:FREEMAN, HEATHER M (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 S SHUYLER ST
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-2198
Mailing Address - Country:US
Mailing Address - Phone:417-251-1750
Mailing Address - Fax:
Practice Address - Street 1:440 S MARKET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2026
Practice Address - Country:US
Practice Address - Phone:417-251-1750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional