Provider Demographics
NPI:1487383048
Name:FRIAS, EDGAR F (MFT)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:F
Last Name:FRIAS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 JACKSON ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1133
Mailing Address - Country:US
Mailing Address - Phone:503-875-7958
Mailing Address - Fax:
Practice Address - Street 1:627 JACKSON ST UNIT A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1133
Practice Address - Country:US
Practice Address - Phone:503-875-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107206106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist