Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003428780 |
---|---|
Provider Name | Cynthia Frazier |
First Address | Fort Worth, TX 76123-1252 |
Second Address | Fort Worth, TX 76123-1252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2020 |
Last Update Date | 23/08/2020 |