Provider Demographics
NPI:1124440698
Name:FRICKE, ELISABETH (MSC, MA)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:FRICKE
Suffix:
Gender:F
Credentials:MSC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 CENTERVILLE LN # B
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-9730
Mailing Address - Country:US
Mailing Address - Phone:775-400-7241
Mailing Address - Fax:
Practice Address - Street 1:1512 US HIGHWAY 395 N
Practice Address - Street 2:SUITE 2
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5282
Practice Address - Country:US
Practice Address - Phone:775-400-7241
Practice Address - Fax:775-782-8637
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00382LC101YA0400X
NVMI0549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)