Provider Demographics
NPI:1003980921
Name:FREY, ERIC DEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DEAN
Last Name:FREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE B103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1980
Mailing Address - Country:US
Mailing Address - Phone:512-358-9700
Mailing Address - Fax:512-687-5377
Practice Address - Street 1:6012 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE B103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1980
Practice Address - Country:US
Practice Address - Phone:512-358-9700
Practice Address - Fax:512-687-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00382PMedicare ID - Type Unspecified