Provider Demographics
NPI:1043086275
Name:FRACHISEUR, JAYCE MICHAEL
Entity Type:Individual
Prefix:
First Name:JAYCE
Middle Name:MICHAEL
Last Name:FRACHISEUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VESTAVIA PKWY STE 2400
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3797
Mailing Address - Country:US
Mailing Address - Phone:205-490-5364
Mailing Address - Fax:
Practice Address - Street 1:200 VESTAVIA PKWY STE 2400
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3797
Practice Address - Country:US
Practice Address - Phone:205-490-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician