Provider Demographics
NPI:1851487870
Name:FREDERICK, DENNIS G (PHD)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:FREDERICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33309 - 1ST WAY SOUTH
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6260
Mailing Address - Country:US
Mailing Address - Phone:253-952-2556
Mailing Address - Fax:253-952-6356
Practice Address - Street 1:33309 - 1ST WAY SOUTH
Practice Address - Street 2:SUITE 203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6260
Practice Address - Country:US
Practice Address - Phone:253-952-2556
Practice Address - Fax:253-952-6356
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health