Provider Demographics
NPI:1407698590
Name:FREEMAN, TAYTELAN (RBT)
Entity type:Individual
Prefix:
First Name:TAYTELAN
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 WOODWIND WAY
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6411
Mailing Address - Country:US
Mailing Address - Phone:479-739-1657
Mailing Address - Fax:
Practice Address - Street 1:5604 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3224
Practice Address - Country:US
Practice Address - Phone:479-926-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician