Provider Demographics
NPI:1831227909
Name:CHARLES T FRIES EDD PC
Entity type:Organization
Organization Name:CHARLES T FRIES EDD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHARLES T FRIES EDD PC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:903-526-5550
Mailing Address - Street 1:3800 PALUXY DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-526-5550
Mailing Address - Fax:903-526-5551
Practice Address - Street 1:3800 PALUXY DR
Practice Address - Street 2:SUITE 440
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-526-5550
Practice Address - Fax:903-526-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19298101YP2500X
TX17645101YP2500X
TX21305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84575LOtherBLUE CROSS BLUE SHIELD JU
TX81478POtherBLUE CROSS BLUE SHIELD CH
TX81478PMedicare ID - Type UnspecifiedCHARLES T FRIES EDD