Provider Demographics
NPI:1497375265
Name:FRYE, MELANIE (LPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:IACANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-0304
Mailing Address - Country:US
Mailing Address - Phone:440-781-4932
Mailing Address - Fax:
Practice Address - Street 1:3217 W CREEK CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4904
Practice Address - Country:US
Practice Address - Phone:440-781-4932
Practice Address - Fax:440-799-4346
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0234039Medicaid