Provider Demographics
NPI:1639806185
Name:SHREVE, FREELAND (MED, NCC)
Entity type:Individual
Prefix:
First Name:FREELAND
Middle Name:
Last Name:SHREVE
Suffix:
Gender:M
Credentials:MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SW 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6518
Mailing Address - Country:US
Mailing Address - Phone:646-496-2344
Mailing Address - Fax:
Practice Address - Street 1:5319 SW WESTGATE DR STE 113
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2432
Practice Address - Country:US
Practice Address - Phone:503-928-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR10147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health