# FREEDOM LOUNGE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275154585
- **Authorized official:** GEORGE MICHAEL WICKHAM (GENERAL PARTNER)
- **Authorized official phone:** (480) 531-5973

## Contact information

- **Practice address:** 209 E BASELINE RD STE E107, TEMPE, AZ 85283-1299
- **Practice address phone:** (480) 531-5973
- **Practice address fax:** (480) 542-8173
- **Mailing address:** 209 E BASELINE RD STE E107, TEMPE, AZ 85283-1299
- **Mailing address phone:** (480) 531-5973
- **Mailing address fax:** (480) 542-8173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/28/2020
- **Last updated:** 04/28/2020