Provider Demographics
NPI:1639881493
Name:FREEDOM, JOHN (CEHP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FREEDOM
Suffix:
Gender:M
Credentials:CEHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 OAK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-6412
Mailing Address - Country:US
Mailing Address - Phone:520-241-5124
Mailing Address - Fax:
Practice Address - Street 1:8901 OAK TRAIL DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-6412
Practice Address - Country:US
Practice Address - Phone:520-241-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor