Provider Demographics
NPI:1922150655
Name:JOHNSON FRY, KATINA N (MS, MFT, MHC)
Entity Type:Individual
Prefix:MS
First Name:KATINA
Middle Name:N
Last Name:JOHNSON FRY
Suffix:
Gender:F
Credentials:MS, MFT, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34152
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-0152
Mailing Address - Country:US
Mailing Address - Phone:317-509-7041
Mailing Address - Fax:317-845-9068
Practice Address - Street 1:5170 E 65TH ST
Practice Address - Street 2:STE 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4892
Practice Address - Country:US
Practice Address - Phone:317-845-8475
Practice Address - Fax:317-845-9068
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health