Provider Demographics
NPI:1972524148
Name:FRIESEN, DOUGLAS L (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-1602
Mailing Address - Country:US
Mailing Address - Phone:717-665-2675
Mailing Address - Fax:717-665-6193
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-1602
Practice Address - Country:US
Practice Address - Phone:717-665-2675
Practice Address - Fax:717-665-6193
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009010L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist