Provider Demographics
NPI:1528887239
Name:FRICKEY, ELISE ANN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:ANN
Last Name:FRICKEY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:ANN
Other - Last Name:BYRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 UNIVERSITY AVE W STE 12
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3952
Mailing Address - Country:US
Mailing Address - Phone:651-379-5157
Mailing Address - Fax:
Practice Address - Street 1:1600 UNIVERSITY AVE W STE 12
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3952
Practice Address - Country:US
Practice Address - Phone:651-379-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP7108103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling