Provider Demographics
NPI:1659986495
Name:KENNETHA L. FRY PHD PLLC
Entity Type:Organization
Organization Name:KENNETHA L. FRY PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-771-1326
Mailing Address - Street 1:2626 S LOOP W STE 545
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2679
Mailing Address - Country:US
Mailing Address - Phone:281-771-1326
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 545
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2679
Practice Address - Country:US
Practice Address - Phone:281-771-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty