MEDICARE: DR. ERIC DEAN FREY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	31405	TX

General Provider Information

NPI Number	:	1003980921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DEAN FREY PH.D.

Provider Business Mailing Address
First Line	:	6012 W WILLIAM CANNON DR
Second Line	:	SUITE B103
City	:	AUSTIN
State	:	TX
Zip	:	78749-1980
Country	:	US
Telephone Number	:	512-358-9700
Fax Number	:	512-687-5377

Provider Business Practice Location Address
First Line	:	6012 W WILLIAM CANNON DR
Second Line	:	SUITE B103
City	:	AUSTIN
State	:	TX
Zip	:	78749-1980
Country	:	US
Telephone Number	:	512-358-9700
Fax Number	:	512-687-5377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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