Provider Demographics
NPI:1417165994
Name:NORRIS, FREDERIC W (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:W
Last Name:NORRIS
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 1:141 DUESENBERG DR.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-495-4747
Mailing Address - Fax:805-497-4647
Practice Address - Street 1:141 DUESENBERG DR.
Practice Address - Street 2:SUITE 2
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-495-4747
Practice Address - Fax:805-497-4647
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10990103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling