Provider Demographics
NPI:1326151945
Name:FRICKE, MARY REAGAN (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:REAGAN
Last Name:FRICKE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:MILLER
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18100 UPPER BAY RD
Mailing Address - Street 2:#106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-798-7016
Mailing Address - Fax:
Practice Address - Street 1:18100 UPPER BAY RD
Practice Address - Street 2:#106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-798-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004342550OtherAETNA
TX2172LCOtherBCBS