Provider Demographics
NPI:1558016469
Name:FRETZ, TAYAH LYNN (MA)
Entity Type:Individual
Prefix:
First Name:TAYAH
Middle Name:LYNN
Last Name:FRETZ
Suffix:
Gender:F
Credentials:MA
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 266
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-0266
Mailing Address - Country:US
Mailing Address - Phone:484-226-7850
Mailing Address - Fax:
Practice Address - Street 1:110 MILTON LN
Practice Address - Street 2:
Practice Address - City:SAYLORSBURG
Practice Address - State:PA
Practice Address - Zip Code:18353-8090
Practice Address - Country:US
Practice Address - Phone:484-226-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional