Provider Demographics
NPI:1558765024
Name:FREI, MICHELLE LEE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:FREI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4300
Mailing Address - Country:US
Mailing Address - Phone:701-663-8228
Mailing Address - Fax:701-663-0912
Practice Address - Street 1:100 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-4300
Practice Address - Country:US
Practice Address - Phone:701-663-8228
Practice Address - Fax:701-663-0912
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1456101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)