Basic Information
| Provider Information | |||||||||
| NPI: | 1477973345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREY | ||||||||
| FirstName: | LAUREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2508 HAZELTON ETNA RD SW | ||||||||
| Address2: | |||||||||
| City: | PATASKALA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430629118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405041241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 E DUBLIN GRANVILLE RD | ||||||||
| Address2: | BUILDING G | ||||||||
| City: | WORTHINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430853192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144367837 | ||||||||
| FaxNumber: | 6144368704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2014 | ||||||||
| LastUpdateDate: | 04/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0145767 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.