Provider Demographics
NPI:1801666565
Name:FREEDOM WITHIN CHILD, ADOLESCENT, AND FAMILY PSYCHIATRY, LLC
Entity type:Organization
Organization Name:FREEDOM WITHIN CHILD, ADOLESCENT, AND FAMILY PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC, PMHCN
Authorized Official - Phone:602-762-2191
Mailing Address - Street 1:PO BOX 95590
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0590
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:
Practice Address - Street 1:16165 N 83RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5816
Practice Address - Country:US
Practice Address - Phone:602-527-9575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty