Provider Demographics
NPI:1083286256
Name:FREY, MARIE THORA (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:THORA
Last Name:FREY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THORA
Other - Last Name:HAWK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:532 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1810
Mailing Address - Country:US
Mailing Address - Phone:509-217-0656
Mailing Address - Fax:
Practice Address - Street 1:532 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1810
Practice Address - Country:US
Practice Address - Phone:509-217-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60017475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional