Provider Demographics
NPI:1326157041
Name:FREYTAG, CAROL (COTA/L)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FREYTAG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731546
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0015
Mailing Address - Country:US
Mailing Address - Phone:253-840-0709
Mailing Address - Fax:
Practice Address - Street 1:VETERAN AFFAIRS PUGET SOUND HEALTHCARE SYSTEM
Practice Address - Street 2:AMERICAN LAKE DIVISION
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-5000
Practice Address - Country:US
Practice Address - Phone:253-582-8440
Practice Address - Fax:253-589-4042
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor