Provider Demographics
NPI:1477791663
Name:FRY, DANIEL E (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
Last Name:FRY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 KIMBALL DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1220
Mailing Address - Country:US
Mailing Address - Phone:253-858-2224
Mailing Address - Fax:253-858-2254
Practice Address - Street 1:6712 KIMBALL DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1220
Practice Address - Country:US
Practice Address - Phone:253-858-2224
Practice Address - Fax:253-858-2254
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical