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General NPI Number Information
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NPI Number | 1740396886
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Entity Type | Individual
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Provider Name | FREDERICK P LIST PHD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 200 PATEWOOD DR SUITE A200
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City | GREENVILLE
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State | SC
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Zip | 29615-3593
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Country | US
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Telephone | 864-454-5115
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Fax | 864-454-5146
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Provider Business Mailing Address
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Address Line | 1 INDEPENDENCE PT STE 212
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City | GREENVILLE
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State | SC
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Zip | 29615-4536
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Country | US
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Telephone |
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Fax | 864-797-6198
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1086
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License Number State | SC
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