Provider Demographics
NPI:1134962426
Name:FREITAG, SUSANNE KATHARINA (LPC, ATR-BC, LCAT)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:KATHARINA
Last Name:FREITAG
Suffix:
Gender:F
Credentials:LPC, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:OR
Mailing Address - Zip Code:97368-9620
Mailing Address - Country:US
Mailing Address - Phone:702-545-7788
Mailing Address - Fax:
Practice Address - Street 1:5555 N HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:OR
Practice Address - Zip Code:97368-9620
Practice Address - Country:US
Practice Address - Phone:702-545-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty