Healthcare Provider Details

I. General information

NPI: 1619323896
Provider Name (Legal Business Name): MANUELA FRYE CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

2709 S OAKLAND CIR W
AURORA CO
80014-3121
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-2716
  • Fax:
Mailing address:
  • Phone: 303-550-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7295
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: