Provider Demographics
NPI:1699701896
Name:FREEMAN, JEANNETTE IRENE (LPAT)
Entity type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:IRENE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CAMINO DEL SUR
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-7448
Mailing Address - Country:US
Mailing Address - Phone:505-286-0057
Mailing Address - Fax:
Practice Address - Street 1:1010 LAS LOMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2634
Practice Address - Country:US
Practice Address - Phone:505-246-8700
Practice Address - Fax:505-246-8706
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0068422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional