Provider Demographics
NPI:1649392952
Name:FREEMAN, JUSTIN WARD (MA, LCPC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:WARD
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1671
Mailing Address - Country:US
Mailing Address - Phone:217-259-2366
Mailing Address - Fax:217-774-9596
Practice Address - Street 1:220 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1671
Practice Address - Country:US
Practice Address - Phone:217-259-2366
Practice Address - Fax:217-774-9596
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0008732006OtherBLUE CROSS BLUE SHIELD ID