MEDICARE: CHARISE FRAZIER

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568893923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARISE FRAZIER

Provider Business Mailing Address
First Line	:	1931 NW 11TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-2232
Country	:	US
Telephone Number	:	405-604-8090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 NW 11TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-2232
Country	:	US
Telephone Number	:	405-604-8090
Fax Number	:

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

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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Directions to “ CHARISE FRAZIER ” Practice Location

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