Provider Demographics
NPI:1760859813
Name:DERRICK FREEMAN
Entity Type:Organization
Organization Name:DERRICK FREEMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-905-9670
Mailing Address - Street 1:5630 CROWDER BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2429
Mailing Address - Country:US
Mailing Address - Phone:504-905-9670
Mailing Address - Fax:504-241-6007
Practice Address - Street 1:5630 CROWDER BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2429
Practice Address - Country:US
Practice Address - Phone:504-905-9670
Practice Address - Fax:504-241-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASA0010691251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health