Provider Demographics
NPI:1477340743
Name:FREY, MICAH
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:FREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 ROCKINGHAM LOOP
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4854
Mailing Address - Country:US
Mailing Address - Phone:217-549-7188
Mailing Address - Fax:
Practice Address - Street 1:2809 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7382
Practice Address - Country:US
Practice Address - Phone:217-549-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health