Provider Demographics
NPI:1902038532
Name:FREY, ERIC ROBERT (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ROBERT
Last Name:FREY
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 S DOBSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6488
Mailing Address - Country:US
Mailing Address - Phone:619-550-6368
Mailing Address - Fax:714-784-7516
Practice Address - Street 1:2266 S DOBSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6488
Practice Address - Country:US
Practice Address - Phone:619-550-6368
Practice Address - Fax:714-784-7516
Is Sole Proprietor?:No
Enumeration Date:2009-08-15
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51103K00000X
AZ1-04-1905103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst