Provider Demographics
NPI:1346237062
Name:FRAY, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:FRAY
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:PO BOX 7242
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-7242
Mailing Address - Country:US
Mailing Address - Phone:540-899-7762
Mailing Address - Fax:540-899-3733
Practice Address - Street 1:24 TALLY HO DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-3307
Practice Address - Country:US
Practice Address - Phone:540-899-7762
Practice Address - Fax:540-899-3733
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA066918OtherANTHEM PROVIDER NUMBER
VA186949OtherVALUEOPTIONS PROVIDER NUM
VA190002170Medicare PIN