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General NPI Number Information
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NPI Number | 1376936336
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Entity Type | Individual
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Provider Name | MICHELLE NICOLE FRY MA, CRC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2015
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 4110 LITT DR
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City | HILLSIDE
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State | IL
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Zip | 60162-1120
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Country | US
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Telephone | 708-547-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 498 THUNDERBIRD TRL
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City | CAROL STREAM
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State | IL
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Zip | 60188-1584
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Country | US
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Telephone | 630-347-2925
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 00116763
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.009665
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License Number State | IL
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