MEDICARE: LYDIA E FRIESE LPC

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	101YM0800X	Mental Health Counselor	86941	TX

General Provider Information

NPI Number	:	1295473056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA E FRIESE LPC

Provider Business Mailing Address
First Line	:	5650 WORTH PKWY APT 2207
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1511
Country	:	US
Telephone Number	:	210-504-7884
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 WORTH PKWY APT 2207
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1511
Country	:	US
Telephone Number	:	210-504-7884
Fax Number	:

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

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	01/06/2024

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