Provider Demographics
NPI:1780311373
Name:FREEMAN, ISAAC GREGORY (BSW, MSW, LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:GREGORY
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:BSW, MSW, LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 COUNTY ROAD 816
Mailing Address - Street 2:
Mailing Address - City:BLACK
Mailing Address - State:MO
Mailing Address - Zip Code:63625-9115
Mailing Address - Country:US
Mailing Address - Phone:573-269-4291
Mailing Address - Fax:573-269-4202
Practice Address - Street 1:525 COUNTY ROAD 816
Practice Address - Street 2:
Practice Address - City:BLACK
Practice Address - State:MO
Practice Address - Zip Code:63625-9115
Practice Address - Country:US
Practice Address - Phone:573-269-4291
Practice Address - Fax:573-269-4202
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240380371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical