Provider Demographics
NPI:1528748811
Name:FRIEDL, CONSTANCE MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MARIE
Last Name:FRIEDL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 UECKER DR APT 11210
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8972
Mailing Address - Country:US
Mailing Address - Phone:972-965-6442
Mailing Address - Fax:
Practice Address - Street 1:4100 FAIRWAY DR STE 200
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6527
Practice Address - Country:US
Practice Address - Phone:972-221-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127801363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health