Provider Demographics
NPI:1275659625
Name:FRYE, REGENA (BA)
Entity Type:Individual
Prefix:
First Name:REGENA
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 N OAK AVE
Mailing Address - Street 2:ROOM 20-21
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3267
Mailing Address - Country:US
Mailing Address - Phone:580-332-3001
Mailing Address - Fax:580-332-3652
Practice Address - Street 1:704 N OAK AVE
Practice Address - Street 2:ROOM 20-21
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3267
Practice Address - Country:US
Practice Address - Phone:580-332-3001
Practice Address - Fax:580-332-3652
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)