Healthcare Provider Details

I. General information

NPI: 1588574032
Provider Name (Legal Business Name): AUTISM AND PSYCHOLOGICAL EVALUATION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 E BARNETT RD
MEDFORD OR
97504-8284
US

IV. Provider business mailing address

1611 E BARNETT RD
MEDFORD OR
97504-8284
US

V. Phone/Fax

Practice location:
  • Phone: 541-690-2906
  • Fax: 541-236-1555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY FRY
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 941-932-6341