Basic Information
| Provider Information | |||||||||
| NPI: | 1992369664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREITAG | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 DUNLAP ST S APT 23 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551052765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125813291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3450 OLEARY LN | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551232340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514540114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2019 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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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 | 1997 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.