Basic Information
| Provider Information | |||||||||
| NPI: | 1063702850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | MARCIE | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 576 OLIVE ST | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974012642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413447303 | ||||||||
| FaxNumber: | 5416866283 | ||||||||
| Practice Location | |||||||||
| Address1: | 576 OLIVE ST | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974012642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413447303 | ||||||||
| FaxNumber: | 5416866283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 04/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.