Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1385 | CO |
Y | 103TC0700X | Clinical Psychologist | 1385 | CO |
N | 103TH0004X | Health Psychologist | 1385 | CO |
N | 103TH0100X | Health Service | 1385 | CO |
N | 103TP2701X | Group Psychotherapist | 1385 | CO |
NPI | 1053700344 |
---|---|
Provider Name | Dr. William Douglas Frost |
First Address | Santa Fe, NM 87505-0347 |
Second Address | Santa Fe, NM 87505-0347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2015 |
Last Update Date | 09/01/2015 |