Provider Demographics
NPI:1043388341
Name:FRIES, SHARON R (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:FRIES
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 LAKE ST S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2639
Mailing Address - Country:US
Mailing Address - Phone:651-230-0492
Mailing Address - Fax:651-982-6035
Practice Address - Street 1:2233 HAMLINE AVE N
Practice Address - Street 2:SUITE 609
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5009
Practice Address - Country:US
Practice Address - Phone:651-230-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0938106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN275K4LIOtherBLUE CROSS BLUE SHIELD
MN1601130-00Medicaid