Provider Demographics
NPI:1932746468
Name:BE FREE LIFESTYLE MEDICINE LLC
Entity Type:Organization
Organization Name:BE FREE LIFESTYLE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:425-344-8513
Mailing Address - Street 1:2333 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3346
Mailing Address - Country:US
Mailing Address - Phone:425-344-8513
Mailing Address - Fax:
Practice Address - Street 1:110 CEDAR AVE APT 101
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2959
Practice Address - Country:US
Practice Address - Phone:360-282-4014
Practice Address - Fax:360-282-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service