Provider Demographics
NPI:1447728530
Name:THIS IS WHAT FREEDOM FEELS LIKE LLC
Entity type:Organization
Organization Name:THIS IS WHAT FREEDOM FEELS LIKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JERALYN
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:937-248-5978
Mailing Address - Street 1:8801 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1380
Mailing Address - Country:US
Mailing Address - Phone:937-985-0428
Mailing Address - Fax:
Practice Address - Street 1:8801 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1380
Practice Address - Country:US
Practice Address - Phone:937-985-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty