Provider Demographics
NPI:1679996342
Name:FRIES, BRETT LEE (LIMHP)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:LEE
Last Name:FRIES
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4036
Mailing Address - Country:US
Mailing Address - Phone:308-237-6865
Mailing Address - Fax:308-236-7698
Practice Address - Street 1:2811 30TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4036
Practice Address - Country:US
Practice Address - Phone:083-237-6865
Practice Address - Fax:308-236-7698
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9963101YM0800X
NE4506101YM0800X, 103T00000X
NE1426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist