Provider Demographics
NPI:1417557224
Name:FRYAR, SHELBY (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:FRYAR
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 SUGAR PINE DR
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-8958
Mailing Address - Country:US
Mailing Address - Phone:423-888-6449
Mailing Address - Fax:
Practice Address - Street 1:707 GEORGIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2073
Practice Address - Country:US
Practice Address - Phone:423-207-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional