Provider Demographics
NPI:1437986155
Name:FRY, EMILY (MED, LPC-A, NPT-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:MED, LPC-A, NPT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75151-0042
Mailing Address - Country:US
Mailing Address - Phone:469-305-8214
Mailing Address - Fax:
Practice Address - Street 1:2419 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4983
Practice Address - Country:US
Practice Address - Phone:469-305-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional