Provider Demographics
NPI:1124657614
Name:FRAZEL, ALIE
Entity type:Individual
Prefix:
First Name:ALIE
Middle Name:
Last Name:FRAZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 MALLARD RD #39
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:FL
Mailing Address - Zip Code:32138
Mailing Address - Country:US
Mailing Address - Phone:904-505-7847
Mailing Address - Fax:
Practice Address - Street 1:3850 NW 83RD ST # 201
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5601
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician