Provider Demographics
NPI:1962760512
Name:FREEDOM MENTAL HEALTH CONSULTANTS, LLC
Entity type:Organization
Organization Name:FREEDOM MENTAL HEALTH CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROKAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, OSW-C
Authorized Official - Phone:772-781-0219
Mailing Address - Street 1:2401 PGA BLVD
Mailing Address - Street 2:SUITE 196
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3590
Mailing Address - Country:US
Mailing Address - Phone:772-781-0219
Mailing Address - Fax:
Practice Address - Street 1:2401 PGA BLVD
Practice Address - Street 2:SUITE 196
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3590
Practice Address - Country:US
Practice Address - Phone:772-781-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9906261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)