Provider Demographics
NPI:1639040033
Name:FREEBORN, JAIME (PPS)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:FREEBORN
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25631 PETER A HARTMAN WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3142
Mailing Address - Country:US
Mailing Address - Phone:949-837-6682
Mailing Address - Fax:
Practice Address - Street 1:23391 DUNE MEAR RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3819
Practice Address - Country:US
Practice Address - Phone:949-837-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220012983101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor