Organization
FIRESIDE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY JOSEPH FREITAS PHD (OWNER, LICENSED PSYCHOLOGIST)
(952) 373-1279
Entity
Organization
Contact information
Practice address
9352 OAK AVE, WACONIA, MN 55387-9422
(952) 373-1279
(844) 762-3234
Mailing address
9352 OAK AVE, WACONIA, MN 55387-9422
(952) 270-2086
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 4675
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680002139
MEDICARE
—
Enumeration date
02/24/2012
Last updated
01/27/2026
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