Provider Demographics
NPI:1386718856
Name:FREASE MCMAHAN, LYNNE GAIL (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:LYNNE
Middle Name:GAIL
Last Name:FREASE MCMAHAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE NW STE 1300
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1331
Mailing Address - Country:US
Mailing Address - Phone:712-707-9988
Mailing Address - Fax:712-707-9961
Practice Address - Street 1:400 CENTRAL AVE NW STE 1300
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1331
Practice Address - Country:US
Practice Address - Phone:712-707-9988
Practice Address - Fax:712-707-9961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11249Medicaid