Provider Demographics
NPI:1487080982
Name:FRY, ELISE GRACE (BS)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:GRACE
Last Name:FRY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:ELISE
Other - Middle Name:GRACE
Other - Last Name:GRISSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S. 4TH STREET
Mailing Address - Street 2:FAMILY SOLUTIONS
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502
Mailing Address - Country:US
Mailing Address - Phone:541-665-0359
Mailing Address - Fax:541-665-0358
Practice Address - Street 1:640 S. 2ND STREET
Practice Address - Street 2:FAMILY SOLUTIONS
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502
Practice Address - Country:US
Practice Address - Phone:541-665-0359
Practice Address - Fax:541-665-0358
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst