Provider Demographics
NPI:1366802969
Name:PEDRO-FRYE, JO VIERRIA (MS, QMHP-C, CADC 1)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:VIERRIA
Last Name:PEDRO-FRYE
Suffix:
Gender:F
Credentials:MS, QMHP-C, CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1204
Mailing Address - Country:US
Mailing Address - Phone:541-215-9106
Mailing Address - Fax:
Practice Address - Street 1:307 MEADOW CT
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1204
Practice Address - Country:US
Practice Address - Phone:541-215-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18-01-26101YA0400X
ORR8016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)