Provider Demographics
NPI:1396425138
Name:FREDRIKSEN MENTAL HEALTH COUNSELING PC
Entity type:Organization
Organization Name:FREDRIKSEN MENTAL HEALTH COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:FREDRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, LMFT
Authorized Official - Phone:607-677-4052
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:FORT PLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:13339-9998
Mailing Address - Country:US
Mailing Address - Phone:607-677-4052
Mailing Address - Fax:
Practice Address - Street 1:3212 COUNTY HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13320-3702
Practice Address - Country:US
Practice Address - Phone:607-677-4052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty