Provider Demographics
NPI:1700147196
Name:AMBER FRY COUNSELING, PC
Entity Type:Organization
Organization Name:AMBER FRY COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA/LIMHP
Authorized Official - Phone:402-315-3522
Mailing Address - Street 1:1710 N 144TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4715
Mailing Address - Country:US
Mailing Address - Phone:402-315-3522
Mailing Address - Fax:402-614-6174
Practice Address - Street 1:1710 N 144TH ST
Practice Address - Street 2:STE 4
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4715
Practice Address - Country:US
Practice Address - Phone:402-315-3522
Practice Address - Fax:402-614-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty