Basic Information
| Provider Information | |||||||||
| NPI: | 1750811600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREDLUND | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | HALLAS | ||||||||
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| OtherLastName: | HALLAS | ||||||||
| OtherFirstName: | HELEN | ||||||||
| OtherMiddleName: | ANDRIANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 65 CORYPHODON LN | ||||||||
| Address2: | |||||||||
| City: | JEMEZ SPRINGS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870259519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057090033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 SHEEP SPRINGS WAY | ||||||||
| Address2: | |||||||||
| City: | JEMEZ PUEBLO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758347258 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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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 | T-0187421 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.