MEDICARE: DR. RENA MAE FRYE 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	101YM0800X	Mental Health Counselor	LH00008917	WA
2	103TC0700X	Clinical Psychologist	PY60026306	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841435716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENA MAE FRYE PH.D

Provider Business Mailing Address
First Line	:	3400 HARBOR AVE SW
Second Line	:	STE 414; MAILBOX #409
City	:	SEATTLE
State	:	WA
Zip	:	98126-2394
Country	:	US
Telephone Number	:	206-683-7637
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 HARBOR AVE SW
Second Line	:	STE 414; MAILBOX #409
City	:	SEATTLE
State	:	WA
Zip	:	98126-2394
Country	:	US
Telephone Number	:	206-683-7637
Fax Number	:	206-946-1318

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	04/13/2017

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