Basic Information
| Provider Information | |||||||||
| NPI: | 1932682184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FROSE | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | FISHEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D., CCSH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 S ABALONE DR | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852335642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178963231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4555 E INVERNESS AVE STE 112 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803610110 | ||||||||
| FaxNumber: | 4808303901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2018 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.