Provider Demographics
NPI:1467647891
Name:DR. ERIC FREY, PC
Entity Type:Organization
Organization Name:DR. ERIC FREY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-358-9700
Mailing Address - Street 1:6012 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE B103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1980
Mailing Address - Country:US
Mailing Address - Phone:512-358-9700
Mailing Address - Fax:512-687-5377
Practice Address - Street 1:6012 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE B103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1980
Practice Address - Country:US
Practice Address - Phone:512-358-9700
Practice Address - Fax:512-687-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31405261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025PSOtherBLUE CROSS BLUE SHIELD