Provider Demographics
NPI:1083420798
Name:FAITH AND FREEDOM THERAPY LLC
Entity type:Organization
Organization Name:FAITH AND FREEDOM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FASSE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-344-3144
Mailing Address - Street 1:974 73RD ST STE 24
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-1200
Mailing Address - Country:US
Mailing Address - Phone:515-344-3144
Mailing Address - Fax:
Practice Address - Street 1:974 73RD ST STE 24
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-1200
Practice Address - Country:US
Practice Address - Phone:515-344-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty