Provider Demographics
NPI:1770620858
Name:LINDA D FRITCHEY
Entity type:Organization
Organization Name:LINDA D FRITCHEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-774-4198
Mailing Address - Street 1:411 HISTORIC ROUTE 66 WEST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583
Mailing Address - Country:US
Mailing Address - Phone:573-774-4198
Mailing Address - Fax:573-774-4951
Practice Address - Street 1:411 HISTORIC ROUTE 66 WEST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-4198
Practice Address - Fax:573-774-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504449208Medicaid