Provider Demographics
NPI:1871652396
Name:FREYMILLER-HAZEN, TONYA A (LPC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:A
Last Name:FREYMILLER-HAZEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E 3RD ST
Mailing Address - Street 2:201
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3478
Mailing Address - Country:US
Mailing Address - Phone:507-452-7292
Mailing Address - Fax:507-457-9887
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4200
Practice Address - Country:US
Practice Address - Phone:608-785-0001
Practice Address - Fax:608-785-0002
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3337-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40924300Medicaid