Provider Demographics
NPI:1942440078
Name:COLLIER-FREED, ROBERT DARRYL
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DARRYL
Last Name:COLLIER-FREED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DARRYL
Other - Middle Name:
Other - Last Name:COLLIER-FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7086 CORPORATE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4298
Mailing Address - Country:US
Mailing Address - Phone:801-540-1212
Mailing Address - Fax:
Practice Address - Street 1:7086 CORPORATE WAY STE 101
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4298
Practice Address - Country:US
Practice Address - Phone:801-541-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6030587-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist