Doctor Name: | THOMAS L FRYDENGER |
NPI Number: | 1285644690 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, LCPC |
License Number: | |
Business Practice Address: | 20548 Timbered Estates Ln Carlinville, IL - 626263947 |
Business Phone Number: | 2178549737 |
Business Fax Number: | 2178543525 |
Mailing Address: | 20548 Timbered Estates Ln, CARLINVILLE |
State: | IL |
Postal Code: | 626263947 |
Phone Number: | 2178549737 |
Fax Number: | 2178543525 |
NPI Enumeration Date: | 08/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |