Provider Demographics
NPI:1699372110
Name:FRAIZE, TOMMY RAY
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:RAY
Last Name:FRAIZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BROYLES ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-8341
Mailing Address - Country:US
Mailing Address - Phone:479-217-4122
Mailing Address - Fax:
Practice Address - Street 1:14 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3905
Practice Address - Country:US
Practice Address - Phone:479-430-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician