Provider Demographics
NPI:1174629729
Name:FRYE, CAROL C (LPC LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:C
Last Name:FRYE
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-2628
Mailing Address - Country:US
Mailing Address - Phone:325-235-9896
Mailing Address - Fax:325-235-1489
Practice Address - Street 1:301 JENNY GEORGE LANE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556
Practice Address - Country:US
Practice Address - Phone:325-235-9896
Practice Address - Fax:325-235-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13427101YP2500X
TX4655-45637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028343401Medicaid