Provider Demographics
NPI:1821447764
Name:FRAZIER, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FRAZIER
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 1:7080 CARIBOU RIDGE ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3167
Mailing Address - Country:US
Mailing Address - Phone:702-913-9032
Mailing Address - Fax:
Practice Address - Street 1:7080 CARIBOU RIDGE ST
Practice Address - Street 2:UNIT 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3167
Practice Address - Country:US
Practice Address - Phone:702-913-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health