Provider Demographics
NPI:1376939629
Name:FRYE, LAUREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 SEASCAPE WAY APT 210
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0629
Mailing Address - Country:US
Mailing Address - Phone:904-686-6856
Mailing Address - Fax:904-686-6855
Practice Address - Street 1:822 A1A N STE 310
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-8209
Practice Address - Country:US
Practice Address - Phone:904-686-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016269103TC0700X
FLPY9718103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical