| Charles T Fries Edd Pc | |
|
3800 Paluxy Dr Suite 440 Tyler TX 75703 | |
| (903) 526-5550 | |
| (903) 526-5551 |
| Full Name | Charles T Fries Edd Pc |
|---|---|
| Speciality | Psychologist |
| Location | 3800 Paluxy Dr, Tyler, Texas |
| Authorized Official Name and Position | Charles T Fries (PRESIDENT CHARLES T FRIES EDD PC) |
| Authorized Official Contact | 9035265550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles T Fries Edd Pc 3800 Paluxy Dr Suite 440 Tyler TX 75703 Ph: (903) 526-5550 | Charles T Fries Edd Pc 3800 Paluxy Dr Suite 440 Tyler TX 75703 Ph: (903) 526-5550 |
| NPI Number | 1831227909 |
|---|---|
| Provider Enumeration Date | 03/01/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3779740600 |
|---|---|
| Medicare Enrollment ID | O20120206000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831227909 | NPI | - | NPPES |
| 84575L | Other | TX | BLUE CROSS BLUE SHIELD JU |
| 81478P | Other | TX | BLUE CROSS BLUE SHIELD CH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 19298 (Texas) | Primary |
| 101YP2500X | Counselor - Professional | 17645 (Texas) | Primary |
| 103T00000X | Psychologist | 21305 (Texas) | Primary |
| Provider Name | Philip R Taft |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285762120 PECOS PAC ID: 3375508203 Enrollment ID: I20041122000086 |
| Provider Name | Charles T Fries |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003970625 PECOS PAC ID: 2264699198 Enrollment ID: I20120206000312 |
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