Provider Demographics
NPI:1750155255
Name:FREES, AVA MAE (LMSW)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:MAE
Last Name:FREES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 E LOOP RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:MI
Mailing Address - Zip Code:49421-8590
Mailing Address - Country:US
Mailing Address - Phone:712-210-1423
Mailing Address - Fax:
Practice Address - Street 1:96 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-9004
Practice Address - Country:US
Practice Address - Phone:231-854-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011106801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical