Basic Information
| Provider Information | |||||||||
| NPI: | 1073058400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREESE | ||||||||
| FirstName: | TAMMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1742 OREGON ST | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960011717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302267419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1742 OREGON ST | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960011717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302267419 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2016 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 95929 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.