Provider Demographics
NPI:1891705083
Name:FREEMAN, PATRICIA DIANE (M, ED, LPC, NBCC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:DIANE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:M, ED, LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 NW 166TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7215
Mailing Address - Country:US
Mailing Address - Phone:405-905-4188
Mailing Address - Fax:
Practice Address - Street 1:6418 N SANTA FE AVE
Practice Address - Street 2:STE C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9112
Practice Address - Country:US
Practice Address - Phone:405-242-2242
Practice Address - Fax:405-286-1730
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200339060AMedicaid