Provider Demographics
NPI:1366230930
Name:FRAISE, JAMEL L (MA PPSC)
Entity type:Individual
Prefix:
First Name:JAMEL
Middle Name:L
Last Name:FRAISE
Suffix:
Gender:M
Credentials:MA PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26568 PRIMROSE WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3502
Mailing Address - Country:US
Mailing Address - Phone:909-367-3307
Mailing Address - Fax:909-367-3307
Practice Address - Street 1:58001 ONAGA TRL
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-6199
Practice Address - Country:US
Practice Address - Phone:909-367-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool