Healthcare Provider Details

I. General information

NPI: 1720840309
Provider Name (Legal Business Name): ALEXANDRA L FRYE LLC, LLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 FRONT AVE NW
GRAND RAPIDS MI
49504-5366
US

IV. Provider business mailing address

1060 WALKER AVE NW
GRAND RAPIDS MI
49504-4375
US

V. Phone/Fax

Practice location:
  • Phone: 616-207-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023343
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: