Provider Demographics
NPI:1831165091
Name:FRYE, BONNIE J (LPCC-S)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:FRYE
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3948
Mailing Address - Country:US
Mailing Address - Phone:614-885-0920
Mailing Address - Fax:
Practice Address - Street 1:5655 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3948
Practice Address - Country:US
Practice Address - Phone:614-885-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1861568990OtherOHIO MENTOR, INC.