Healthcare Provider Details

I. General information

NPI: 1508072489
Provider Name (Legal Business Name): VICTORIA FRUE MS, LPC, NCC, CSAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA ACTON

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 ODANA RD.
MADISON WI
53719
US

IV. Provider business mailing address

6402 ODANA RD SUITE 106
MADISON WI
53719
US

V. Phone/Fax

Practice location:
  • Phone: 828-301-0097
  • Fax: 828-298-4870
Mailing address:
  • Phone: 828-301-0097
  • Fax: 828-298-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12537
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12537
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2581-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: