Provider Demographics
NPI:1568825941
Name:FRYER, KELSEY CLEWS (MA, PSYD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CLEWS
Last Name:FRYER
Suffix:
Gender:
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 N 900 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9030
Mailing Address - Country:US
Mailing Address - Phone:904-501-9588
Mailing Address - Fax:
Practice Address - Street 1:856 S MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3528
Practice Address - Country:US
Practice Address - Phone:904-501-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9529289-2501103TC0700X
UT95292892501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical