Provider Demographics
NPI:1669667374
Name:FRASER, CHARLENE M (BA, BHRS 1)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:M
Last Name:FRASER
Suffix:
Gender:F
Credentials:BA, BHRS 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5038
Mailing Address - Country:US
Mailing Address - Phone:580-924-7330
Mailing Address - Fax:
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5038
Practice Address - Country:US
Practice Address - Phone:580-924-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health