Provider Demographics
NPI:1225475643
Name:FRIED, DAVID (MA,BA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FRIED
Suffix:
Gender:M
Credentials:MA,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 SHINNERY CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-7407
Mailing Address - Country:US
Mailing Address - Phone:405-743-7870
Mailing Address - Fax:
Practice Address - Street 1:2602 SHINNERY CT
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-7407
Practice Address - Country:US
Practice Address - Phone:405-743-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)