Provider Demographics
NPI:1609127232
Name:KRISTA FREECE PHD PLLC
Entity Type:Organization
Organization Name:KRISTA FREECE PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-981-3100
Mailing Address - Street 1:42180 FORD RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3673
Mailing Address - Country:US
Mailing Address - Phone:734-981-3100
Mailing Address - Fax:
Practice Address - Street 1:42180 FORD RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3673
Practice Address - Country:US
Practice Address - Phone:734-981-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014786251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health