Provider Demographics
NPI:1548368780
Name:FREYHARDT, HANS H (MFT)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:H
Last Name:FREYHARDT
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2045
Mailing Address - Country:US
Mailing Address - Phone:562-983-0498
Mailing Address - Fax:562-432-2515
Practice Address - Street 1:1945 PALO VERDE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3443
Practice Address - Country:US
Practice Address - Phone:562-983-0498
Practice Address - Fax:562-432-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33824106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS003600OtherEPSDT PROVIDER NUMBER