Provider Demographics
NPI:1124300231
Name:FRY, SARAH ANNE (BA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:FRY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 HARDY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7389
Mailing Address - Country:US
Mailing Address - Phone:918-916-6684
Mailing Address - Fax:
Practice Address - Street 1:23 E CHOCTAW AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5098
Practice Address - Country:US
Practice Address - Phone:918-420-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health