Provider Demographics
NPI:1881185882
Name:FREEMAN, MICAH JAMES (MA, PPSC)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:JAMES
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MA, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4808
Mailing Address - Country:US
Mailing Address - Phone:530-251-8721
Mailing Address - Fax:
Practice Address - Street 1:555 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4808
Practice Address - Country:US
Practice Address - Phone:530-251-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180097326101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty