| Doctor Name: | BOBBI JEAN FRADY |
| NPI Number: | 1124108055 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MC,LADAC |
| License Number: | 3699 |
| Business Practice Address: | 750 Morris Rd Se Los Lunas, NM - 870315242 |
| Business Phone Number: | 5058662318 |
| Business Fax Number: | 5058694881 |
| Mailing Address: | 2551 Coors Blvd Nw, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871201213 |
| Phone Number: | |
| Fax Number: | 5058694881 |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 3699 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |