Provider Demographics
NPI:1467816140
Name:FRIDIE-SCOTT, MINNESHA
Entity Type:Individual
Prefix:
First Name:MINNESHA
Middle Name:
Last Name:FRIDIE-SCOTT
Suffix:
Gender:F
Credentials:
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 1576
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-1576
Mailing Address - Country:US
Mailing Address - Phone:281-714-8725
Mailing Address - Fax:
Practice Address - Street 1:505 S 12TH ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3941
Practice Address - Country:US
Practice Address - Phone:281-714-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator