Provider Demographics
NPI:1275694861
Name:FRY, LAWRENCE BRYAN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BRYAN
Last Name:FRY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 E BROWN RD
Mailing Address - Street 2:#35
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4437
Mailing Address - Country:US
Mailing Address - Phone:480-924-4899
Mailing Address - Fax:
Practice Address - Street 1:4250 E. FLORIAN AVE.
Practice Address - Street 2:BLDG. 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-844-1653
Practice Address - Fax:480-539-4947
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional