Provider Demographics
NPI:1184096208
Name:FREIBURGHAUS, STACY (LCPC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:FREIBURGHAUS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5800
Mailing Address - Country:US
Mailing Address - Phone:208-695-8065
Mailing Address - Fax:
Practice Address - Street 1:623 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5800
Practice Address - Country:US
Practice Address - Phone:208-695-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC4781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health