Provider Demographics
NPI:1992341333
Name:FRYE, JOURNEA
Entity type:Individual
Prefix:
First Name:JOURNEA
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8745 PALM BREEZE RD APT 806
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3758
Mailing Address - Country:US
Mailing Address - Phone:904-624-2667
Mailing Address - Fax:
Practice Address - Street 1:6850 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6877
Practice Address - Country:US
Practice Address - Phone:904-201-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-22-13529103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-22-13529OtherBEHAVIOR ANALYST CERTIFICATION BOARD
FL105417300Medicaid