Provider Demographics
NPI:1154897056
Name:FREEMAN, LAURA LYNN (BSP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:BSP
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:BAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:481 BAYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9213
Mailing Address - Country:US
Mailing Address - Phone:616-558-2077
Mailing Address - Fax:
Practice Address - Street 1:5380 HOLIDAY TER STE 37
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2176
Practice Address - Country:US
Practice Address - Phone:616-558-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty