Provider Demographics
NPI:1124192331
Name:FREVILLE, MICHAEL EARLE (PHDDD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EARLE
Last Name:FREVILLE
Suffix:
Gender:M
Credentials:PHDDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 DOVE CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4680
Mailing Address - Country:US
Mailing Address - Phone:502-254-1582
Mailing Address - Fax:502-254-2900
Practice Address - Street 1:10418 DOVE CHASE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4680
Practice Address - Country:US
Practice Address - Phone:502-254-1582
Practice Address - Fax:502-254-2900
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health