Provider Demographics
NPI:1154372613
Name:FRAZIER, TYRONE (LCSW)
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3514
Mailing Address - Country:US
Mailing Address - Phone:773-651-1013
Mailing Address - Fax:
Practice Address - Street 1:7236 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3514
Practice Address - Country:US
Practice Address - Phone:773-651-1013
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical