Provider Demographics
NPI:1144693409
Name:FREEMAN, MICHAEL (F1112101309 RAS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:F1112101309 RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4905
Mailing Address - Country:US
Mailing Address - Phone:562-432-4033
Mailing Address - Fax:
Practice Address - Street 1:443 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4905
Practice Address - Country:US
Practice Address - Phone:562-432-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1112101309 RAS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)