Provider Demographics
NPI:1417533845
Name:FRY, CANDICE L (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:L
Last Name:FRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 S HIDDEN VALLEY DR UNIT 289
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6975
Mailing Address - Country:US
Mailing Address - Phone:435-705-8132
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE R123
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7350
Practice Address - Country:US
Practice Address - Phone:435-705-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12218246-35061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty