Provider Demographics
NPI:1215166772
Name:FRIES, KENNETH J (LMSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:FRIES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425A BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1627
Mailing Address - Country:US
Mailing Address - Phone:512-451-7337
Mailing Address - Fax:512-451-8729
Practice Address - Street 1:5425A BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1627
Practice Address - Country:US
Practice Address - Phone:512-451-7337
Practice Address - Fax:512-451-8729
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53032104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker