Provider Demographics
NPI:1467036673
Name:FREE RANGE MENTAL HEALTH
Entity Type:Organization
Organization Name:FREE RANGE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:D'ELOIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW
Authorized Official - Phone:801-597-3925
Mailing Address - Street 1:2765 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4318
Mailing Address - Country:US
Mailing Address - Phone:801-597-3925
Mailing Address - Fax:
Practice Address - Street 1:2765 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-4318
Practice Address - Country:US
Practice Address - Phone:801-597-3925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty