Provider Demographics
NPI:1497299309
Name:FRITTS, JACQUELINE (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FRITTS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:6044 W BEARD RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-8156
Mailing Address - Country:US
Mailing Address - Phone:210-287-0622
Mailing Address - Fax:
Practice Address - Street 1:6044 W BEARD RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-8156
Practice Address - Country:US
Practice Address - Phone:210-287-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301019339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical