Provider Demographics
NPI:1245608793
Name:FRAZIER, DARVIS T (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARVIS
Middle Name:T
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 WILLIAMSTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3705
Mailing Address - Country:US
Mailing Address - Phone:305-778-3478
Mailing Address - Fax:
Practice Address - Street 1:4938 WILLIAMSTOWN BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3705
Practice Address - Country:US
Practice Address - Phone:305-778-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9412103T00000X
OR2513103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist