Provider Demographics
NPI:1497716732
Name:FREY, FRED CHARLES (PHD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:CHARLES
Last Name:FREY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7656 JEFFERSON HWY
Mailing Address - Street 2:SUITE: 1A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1101
Mailing Address - Country:US
Mailing Address - Phone:225-927-2455
Mailing Address - Fax:225-927-7921
Practice Address - Street 1:7656 JEFFERSON HWY
Practice Address - Street 2:SUITE: 1A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1101
Practice Address - Country:US
Practice Address - Phone:225-927-2455
Practice Address - Fax:225-927-7921
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical