Provider Demographics
NPI:1922790237
Name:FRAIRE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FRAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 S SHORE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2934
Mailing Address - Country:US
Mailing Address - Phone:832-932-3530
Mailing Address - Fax:409-750-7634
Practice Address - Street 1:2555 S SHORE BLVD STE C
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2934
Practice Address - Country:US
Practice Address - Phone:832-932-3530
Practice Address - Fax:409-750-7634
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXUC-F24F6D9D-FB91-433171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach