Healthcare Provider Details

I. General information

NPI: 1477038974
Provider Name (Legal Business Name): TRUDY JOY FRYE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRUDY JOY HEATH

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 12/28/2019
Certification Date: 12/28/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 CANYON LAKE DR
LUBBOCK TX
79415-2000
US

IV. Provider business mailing address

2402 CANYON LAKE DR
LUBBOCK TX
79415-2000
US

V. Phone/Fax

Practice location:
  • Phone: 806-897-9735
  • Fax: 806-762-0838
Mailing address:
  • Phone: 806-897-9735
  • Fax: 806-762-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66791
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: