Provider Demographics
NPI:1275345662
Name:FREEZE, LISA (AA SOCIAL SCIE, MHRS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FREEZE
Suffix:
Gender:F
Credentials:AA SOCIAL SCIE, MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-529-9454
Mailing Address - Fax:530-529-9456
Practice Address - Street 1:590 ANTELOPE BLVD STE 40A
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2477
Practice Address - Country:US
Practice Address - Phone:530-529-9454
Practice Address - Fax:530-529-9456
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker