Provider Demographics
NPI:1568227015
Name:FREEDOM BEHAVIORAL HEALTH TEXAS PLLC
Entity Type:Organization
Organization Name:FREEDOM BEHAVIORAL HEALTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-475-7713
Mailing Address - Street 1:6601 MONTANA AVE STE J
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2143
Mailing Address - Country:US
Mailing Address - Phone:915-234-6227
Mailing Address - Fax:877-839-4682
Practice Address - Street 1:6601 MONTANA AVE STE J
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2143
Practice Address - Country:US
Practice Address - Phone:915-234-6227
Practice Address - Fax:877-839-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty