Provider Demographics
NPI:1538785852
Name:FREUDHAWK PSYCHOLOGICAL ENTERPRISES, LLC
Entity type:Organization
Organization Name:FREUDHAWK PSYCHOLOGICAL ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-643-3451
Mailing Address - Street 1:2115 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6844
Mailing Address - Country:US
Mailing Address - Phone:785-643-3451
Mailing Address - Fax:
Practice Address - Street 1:1307 E IRON AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3231
Practice Address - Country:US
Practice Address - Phone:785-643-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty