Provider Demographics
NPI:1730747254
Name:FREIBERG, TARA MCMULLIN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MCMULLIN
Last Name:FREIBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N 100 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1672
Mailing Address - Country:US
Mailing Address - Phone:435-669-6556
Mailing Address - Fax:
Practice Address - Street 1:4 S 2600 W STE 6
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3247
Practice Address - Country:US
Practice Address - Phone:435-229-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health