Provider Demographics
NPI:1073869681
Name:FRIZZELL, RICHARD (MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FRIZZELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1534
Mailing Address - Country:US
Mailing Address - Phone:941-400-9118
Mailing Address - Fax:941-496-4314
Practice Address - Street 1:708 GOODLETTE-FRANK RD N STE 1
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5644
Practice Address - Country:US
Practice Address - Phone:239-351-0675
Practice Address - Fax:941-496-4314
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766373100Medicaid