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General NPI Number Information
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NPI Number | 1871177253
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Entity Type | Individual
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Provider Name | BRANDI FRYE LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 3989 N 20TH ST
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City | OZARK
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State | MO
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Zip | 65721-7433
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Country | US
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Telephone | 816-366-5515
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Fax | 816-819-5873
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Provider Business Mailing Address
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Address Line | 334 W ELM ST
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City | REPUBLIC
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State | MO
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Zip | 65738-1884
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Country | US
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Telephone | 417-343-9964
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2024005439
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License Number State | MO
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