Basic Information
| Provider Information | |||||||||
| NPI: | 1831225192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPOOLSTRA | ||||||||
| FirstName: | FRIEDA | ||||||||
| MiddleName: | LORRAINE | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8400 LOUISIANA ST | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464106385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197571928 | ||||||||
| FaxNumber: | 2197571950 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 HOHMAN AVE | ||||||||
| Address2: | |||||||||
| City: | HAMMOND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463202423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199310427 | ||||||||
| FaxNumber: | 2199375808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 10/24/2011 | ||||||||
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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 | 101YM0800X | 39002314A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 180004845 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.