Provider Demographics
NPI:1316352990
Name:FREY, ADA
Entity type:Individual
Prefix:MS
First Name:ADA
Middle Name:
Last Name:FREY
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 1:2336 ELDEN AVE APT D
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1570
Mailing Address - Country:US
Mailing Address - Phone:714-654-5818
Mailing Address - Fax:
Practice Address - Street 1:500 CITY PKWY W STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2941
Practice Address - Country:US
Practice Address - Phone:714-480-6600
Practice Address - Fax:714-568-4527
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT78370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist