Basic Information
| Provider Information | |||||||||
| NPI: | 1265940274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LPC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 E STATE ST APT 502 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532023248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148403117 | ||||||||
| FaxNumber: | 4144442435 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532022602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142251399 | ||||||||
| FaxNumber: | 4142251346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2018 | ||||||||
| LastUpdateDate: | 01/16/2018 | ||||||||
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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 | 101YM0800X | 3795-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.