Provider Demographics
NPI:1346435278
Name:FREEMAN, TIELEEN FRANCINE
Entity Type:Individual
Prefix:
First Name:TIELEEN
Middle Name:FRANCINE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 N WESTANNA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2679
Mailing Address - Country:US
Mailing Address - Phone:503-737-0306
Mailing Address - Fax:
Practice Address - Street 1:7515 N WESTANNA AVE APT 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2679
Practice Address - Country:US
Practice Address - Phone:503-737-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 101YM0800X
OR101YA0400X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program