Provider Demographics
NPI:1063801645
Name:FRIERMOOD, CHRISTOPHER (MA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:FRIERMOOD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2102
Mailing Address - Country:US
Mailing Address - Phone:303-717-0825
Mailing Address - Fax:
Practice Address - Street 1:1226 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2102
Practice Address - Country:US
Practice Address - Phone:303-717-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99-299-1126103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
COXFL584M51246OtherANTHEM