Healthcare Provider Details

I. General information

NPI: 1417495532
Provider Name (Legal Business Name): DEKESH FRAZIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLUE HERON BLVD W
RIVIERA BEACH FL
33404-5003
US

IV. Provider business mailing address

2001 BLUE HERON BLVD W
RIVIERA BEACH FL
33404-5003
US

V. Phone/Fax

Practice location:
  • Phone: 561-841-3500
  • Fax: 561-899-1636
Mailing address:
  • Phone: 561-841-3500
  • Fax: 561-899-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: