Provider Demographics
NPI:1386029171
Name:FREER, AMY AMANDA LOU
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:AMANDA LOU
Last Name:FREER
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 1:14868 NW HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5647
Mailing Address - Country:US
Mailing Address - Phone:949-878-1773
Mailing Address - Fax:
Practice Address - Street 1:7555 SW HERMOSO WAY STE 120
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8684
Practice Address - Country:US
Practice Address - Phone:503-345-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2023-11-16
Deactivation Date:2022-07-25
Deactivation Code:
Reactivation Date:2022-08-22
Provider Licenses
StateLicense IDTaxonomies
OR22-397221700000X
ORR7857101YM0800X
OR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health