Provider Demographics
NPI:1932265667
Name:FRY, MARY LOUISE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:FRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 S PFLUMM RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9601
Mailing Address - Country:US
Mailing Address - Phone:913-829-0221
Mailing Address - Fax:913-791-3426
Practice Address - Street 1:14201 S MUR LEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1889
Practice Address - Country:US
Practice Address - Phone:913-829-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional