Provider Demographics
NPI:1417303157
Name:FRITZ, EDGAR TYRONE (LCSW)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:TYRONE
Last Name:FRITZ
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 1:209 FRITTS RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-1225
Mailing Address - Country:US
Mailing Address - Phone:865-765-3797
Mailing Address - Fax:
Practice Address - Street 1:209 FRITTS RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-1225
Practice Address - Country:US
Practice Address - Phone:865-765-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022498Medicaid