Healthcare Provider Details

I. General information

NPI: 1174059141
Provider Name (Legal Business Name): CRYSTAL L. FRAZIER I PSY.D., M.P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11937 US HIGHWAY 271
TYLER TX
75708-3154
US

IV. Provider business mailing address

PO BOX 731912
DALLAS TX
75373-1912
US

V. Phone/Fax

Practice location:
  • Phone: 903-877-7168
  • Fax: 903-877-8356
Mailing address:
  • Phone: 903-877-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: