Provider Demographics
NPI:1265556401
Name:FREESTONE, ALTON TODD (PSYD LCSW)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:TODD
Last Name:FREESTONE
Suffix:
Gender:M
Credentials:PSYD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W CACHE VALLEY BLVD
Mailing Address - Street 2:STE 10A
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-8452
Mailing Address - Country:US
Mailing Address - Phone:435-787-2272
Mailing Address - Fax:435-713-4001
Practice Address - Street 1:40 W CACHE VALLEY BLVD
Practice Address - Street 2:STE 10A
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-8452
Practice Address - Country:US
Practice Address - Phone:435-787-2272
Practice Address - Fax:435-713-4001
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health