Provider Demographics
NPI:1467244897
Name:FREEZE, MICHAEL G SR (MAADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:G
Last Name:FREEZE
Suffix:SR
Gender:M
Credentials:MAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2302
Mailing Address - Country:US
Mailing Address - Phone:417-448-9949
Mailing Address - Fax:417-448-9949
Practice Address - Street 1:124 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2302
Practice Address - Country:US
Practice Address - Phone:417-448-9949
Practice Address - Fax:417-448-9949
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19634101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1184014946Medicaid