Organization
FREEDOM LOUNGE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE MICHAEL WICKHAM (GENERAL PARTNER)
(480) 531-5973
Entity
Organization
Contact information
Practice address
209 E BASELINE RD STE E107, TEMPE, AZ 85283-1299
(480) 531-5973
(480) 542-8173
Mailing address
209 E BASELINE RD STE E107, TEMPE, AZ 85283-1299
(480) 531-5973
(480) 542-8173
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/28/2020
Last updated
04/28/2020
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