| Fireside Counseling Llc | |
|
9350 Oak Ave Waconia MN 55387-5500 | |
| (952) 442-0040 | |
| Not Available |
| Full Name | Fireside Counseling Llc |
|---|---|
| Speciality | Psychologist |
| Location | 9350 Oak Ave, Waconia, Minnesota |
| Authorized Official Name and Position | Gary Joseph Freitas (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 9524420040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fireside Counseling Llc 9350 Oak Ave Po Box 42 Waconia MN 55387-5500 Ph: (952) 270-2086 | Fireside Counseling Llc 9350 Oak Ave Waconia MN 55387-5500 Ph: (952) 442-0040 |
| NPI Number | 1447524285 |
|---|---|
| Provider Enumeration Date | 02/24/2012 |
| Last Update Date | 05/12/2012 |
| Medicare PECOS PAC ID | 5890958136 |
|---|---|
| Medicare Enrollment ID | O20120523000457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447524285 | NPI | - | NPPES |
| 680002139 | Other | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP 4675 (Minnesota) | Primary |
| Provider Name | Gary J Freitas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679598072 PECOS PAC ID: 4486664695 Enrollment ID: I20060503000214 |
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