MEDICARE: HUSSIAN FRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1326551094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUSSIAN FRY

Provider Business Mailing Address
First Line	:	66 ADELAIDE ST APT 18
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-3111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 ADELAIDE ST APT 18
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-3111
Country	:	US
Telephone Number	:	850-200-7292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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Directions to “ HUSSIAN FRY ” Practice Location

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