Provider Demographics
NPI:1972232395
Name:FREISTUHLER, ADAM (QMHS, CDCA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FREISTUHLER
Suffix:
Gender:M
Credentials:QMHS, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-2811
Mailing Address - Country:US
Mailing Address - Phone:419-740-3022
Mailing Address - Fax:419-740-3033
Practice Address - Street 1:111 CLINTON ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2811
Practice Address - Country:US
Practice Address - Phone:419-740-3022
Practice Address - Fax:419-740-3033
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.179758171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator