Provider Demographics
NPI:1750645412
Name:FREEMAN, RUHAMA
Entity Type:Individual
Prefix:
First Name:RUHAMA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NE MCWILLIAMS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3124
Mailing Address - Country:US
Mailing Address - Phone:503-893-4858
Mailing Address - Fax:
Practice Address - Street 1:2250 NW FLANDERS ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5410
Practice Address - Country:US
Practice Address - Phone:503-893-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61201069101YP2500X
ORC4720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH61201069OtherLICENSED MENTAL HEALTH COUNSELOR
ORC4720OtherLICENSED PROFESSIONAL COUNSELOR