Provider Demographics
NPI:1609430958
Name:FRAZIER RECOVERY SERVICES
Entity Type:Organization
Organization Name:FRAZIER RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:REZEK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LADC
Authorized Official - Phone:651-895-4440
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-0142
Mailing Address - Country:US
Mailing Address - Phone:651-895-4440
Mailing Address - Fax:
Practice Address - Street 1:621 MARIE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-2039
Practice Address - Country:US
Practice Address - Phone:651-895-4440
Practice Address - Fax:651-413-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty