Provider Demographics
NPI:1952808867
Name:MY FREEDOM QUEST, INC.
Entity type:Organization
Organization Name:MY FREEDOM QUEST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:407-718-6960
Mailing Address - Street 1:1412 OAK PL APT G
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1901
Mailing Address - Country:US
Mailing Address - Phone:407-718-6960
Mailing Address - Fax:
Practice Address - Street 1:2989 W SR 434 STE 100
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4898
Practice Address - Country:US
Practice Address - Phone:407-786-1913
Practice Address - Fax:407-960-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-07
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNPIOtherNPI