Provider Demographics
NPI:1093430621
Name:FRICKS, KORY (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:KORY
Middle Name:
Last Name:FRICKS
Suffix:
Gender:
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:PIERCY
Mailing Address - State:CA
Mailing Address - Zip Code:95587-0175
Mailing Address - Country:US
Mailing Address - Phone:707-223-0051
Mailing Address - Fax:
Practice Address - Street 1:197 E HAMILTON AVE SUITE 203
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:707-223-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty