Provider Demographics
NPI:1346494630
Name:FREEMAN, MARK STANLEY (LMHC LMFT NCC ACS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STANLEY
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LMHC LMFT NCC ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 N PARK AVE
Mailing Address - Street 2:SUITE # 320
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2359
Mailing Address - Country:US
Mailing Address - Phone:407-620-8096
Mailing Address - Fax:
Practice Address - Street 1:2180 N PARK AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2359
Practice Address - Country:US
Practice Address - Phone:407-620-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC 2649101Y00000X, 101YM0800X, 101YP2500X
FLMT# 1953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional