=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144600412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRICK COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2015
-----------------------------------------------------
Last Update Date | 06/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 CYPRESS CREEK RD
-----------------------------------------------------
City | SEVERNA PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21146-4050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-261-5974
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8632 HOULTON HARBOUR
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21122-2570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-749-4214
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AARYN FRICK
-----------------------------------------------------
Credential | LCSW-C
-----------------------------------------------------
Telephone | 254-749-4214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 20459
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------