Basic Information
| Provider Information | |||||||||
| NPI: | 1467029900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRASIER | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | KAE | ||||||||
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| Credential: | LCDC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 JOSHUA STATION ST APT 3112 | ||||||||
| Address2: | |||||||||
| City: | JOSHUA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760583396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179339593 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6733 CAMP BOWIE BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761167112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173869180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2021 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 51675 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.