Provider Demographics
NPI:1629147616
Name:FRIESEN, NYLE KENNETH (MFC)
Entity Type:Individual
Prefix:MR
First Name:NYLE
Middle Name:KENNETH
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S 13TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-3302
Mailing Address - Country:US
Mailing Address - Phone:805-202-8988
Mailing Address - Fax:805-202-8980
Practice Address - Street 1:200 S 13TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-3302
Practice Address - Country:US
Practice Address - Phone:805-202-8988
Practice Address - Fax:805-202-8980
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist