Provider Demographics
NPI:1366410029
Name:FRYE, TRAVIS EUGENE (LPC)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:EUGENE
Last Name:FRYE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39737 N HIGH NOON WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2376
Mailing Address - Country:US
Mailing Address - Phone:602-316-7134
Mailing Address - Fax:
Practice Address - Street 1:4614 E SHEA BLVD
Practice Address - Street 2:SUITE D-250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3070
Practice Address - Country:US
Practice Address - Phone:602-953-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health