MEDICARE: MARTHA J FRAZIER MA

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	101Y00000X	Counselor	000047	MO

General Provider Information

NPI Number	:	1336125822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA J FRAZIER MA

Provider Business Mailing Address
First Line	:	123 NORTHGATE DR
Second Line	:
City	:	LEBANON
State	:	MO
Zip	:	65536-3861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 DEADRA DR
Second Line	:
City	:	LEBANON
State	:	MO
Zip	:	65536-4669
Country	:	US
Telephone Number	:	417-532-7102
Fax Number	:	417-532-6606

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

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