Provider Demographics
NPI:1861695736
Name:FREEMAN, MICHELLE LIMON (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LIMON
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:LIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2664
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585
Mailing Address - Country:US
Mailing Address - Phone:707-688-5250
Mailing Address - Fax:
Practice Address - Street 1:700 YGNACIO VALLEY RD SUITE 320
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-939-7500
Practice Address - Fax:510-839-3888
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSB#32972103TC2200X
CAPSB# 33649103TC2200X
CAPSY23888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent