Provider Demographics
NPI:1023476892
Name:MARY L. FREEMAN, PH.D.
Entity type:Organization
Organization Name:MARY L. FREEMAN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LUCILE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:337-233-7867
Mailing Address - Street 1:601 W SAINT MARY BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3564
Mailing Address - Country:US
Mailing Address - Phone:337-233-7867
Mailing Address - Fax:
Practice Address - Street 1:601 W SAINT MARY BLVD STE 406
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3564
Practice Address - Country:US
Practice Address - Phone:337-233-7867
Practice Address - Fax:337-235-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA965103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty