Provider Demographics
NPI:1942753298
Name:FRASER, SEKOU (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SEKOU
Middle Name:
Last Name:FRASER
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 PACIFIC AVE STE 17090
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4828
Mailing Address - Country:US
Mailing Address - Phone:469-232-4895
Mailing Address - Fax:
Practice Address - Street 1:1910 PACIFIC AVE STE 17090
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4828
Practice Address - Country:US
Practice Address - Phone:469-232-4895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76078101YP2500X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362018902Medicaid