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General NPI Number Information
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NPI Number | 1366802969
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Entity Type | Individual
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Provider Name | JO VIERRIA PEDRO-FRYE LPC, MS, PMP, CADC 1
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Gender | Female
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 307 MEADOW CT
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City | LA GRANDE
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State | OR
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Zip | 97850-1204
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Country | US
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Telephone | 541-215-9106
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Fax |
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Provider Business Mailing Address
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Address Line | 307 MEADOW CT
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City | LA GRANDE
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State | OR
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Zip | 97850-1204
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Country | US
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Telephone | 541-215-9106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 18-01-26
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C10044
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License Number State | OR
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