Provider Demographics
NPI:1659672434
Name:FREDERICK, ADAM KEITH (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:KEITH
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 GARDENVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-7552
Mailing Address - Country:US
Mailing Address - Phone:940-390-5301
Mailing Address - Fax:
Practice Address - Street 1:1306 N LOCUST ST
Practice Address - Street 2:REFLECTIONS COUNSELING
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6908
Practice Address - Country:US
Practice Address - Phone:940-367-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62988101Y00000X, 101YM0800X, 101YP2500X
TX9105101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health