Provider Demographics
NPI:1316742927
Name:FRAZIER, CHRISTINE CAROL (LPC-IT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CAROL
Last Name:FRAZIER
Suffix:
Gender:
Credentials:LPC-IT
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:CAROL
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 W BROWN ST APT 201
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-1973
Mailing Address - Country:US
Mailing Address - Phone:703-582-9406
Mailing Address - Fax:
Practice Address - Street 1:1807 N CENTER ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1001
Practice Address - Country:US
Practice Address - Phone:920-887-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TF0200X
WI8252-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic