Provider Demographics
NPI:1568238731
Name:F. CHARLES FREY, IV, PH.D., L.L.C.
Entity Type:Organization
Organization Name:F. CHARLES FREY, IV, PH.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FREY
Authorized Official - Suffix:IV
Authorized Official - Credentials:PHD
Authorized Official - Phone:225-937-1449
Mailing Address - Street 1:1326 MEADOW LEA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-8657
Mailing Address - Country:US
Mailing Address - Phone:225-937-1449
Mailing Address - Fax:
Practice Address - Street 1:7414 PERKINS RD STE 130
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4303
Practice Address - Country:US
Practice Address - Phone:225-963-0709
Practice Address - Fax:225-612-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)