Doctor Name: | BRENDA JOY FRICKE |
NPI Number: | 1114077864 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC |
License Number: | 2003002001 |
Business Practice Address: | 402 S Elm Box 798 Dixon, MO - 65459 |
Business Phone Number: | 5735283558 |
Business Fax Number: | 5737746992 |
Mailing Address: | 25945 Sandlewood Ln, Po Box 175 LAQUEY |
State: | MO |
Postal Code: | 655347615 |
Phone Number: | 5735283558 |
Fax Number: | 5737746992 |
NPI Enumeration Date: | 01/12/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2003002001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |