Individual
PAUL B FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
103 SOUTH 19TH AVE, HATTIESBURG, MS 39402
(601) 544-4641
(601) 582-1602
Mailing address
P O BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
51 886
MS
Other
Enumeration date
09/26/2011
Last updated
09/26/2011
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