Provider Demographics
NPI:1588662696
Name:FREEMAN, YURI EDNA (MA)
Entity Type:Individual
Prefix:MS
First Name:YURI
Middle Name:EDNA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:YURI
Other - Middle Name:EDNA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:350 CITY VIEW DR STE 206
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5326
Mailing Address - Country:US
Mailing Address - Phone:307-789-7915
Mailing Address - Fax:307-778-3944
Practice Address - Street 1:350 CITY VIEW DR STE 206
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5326
Practice Address - Country:US
Practice Address - Phone:307-789-7915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC 928101YP2500X
171W00000X
WY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313171OtherBS