Individual
BRIAN PAUL FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
850 KALISTE SALOOM RD, SUITE 105, LAFAYETTE, LA 70508-4230
(337) 237-0788
(337) 237-0785
Mailing address
305 MILL POND DR, YOUNGSVILLE, LA 70592-5655
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
40-005
MS
103T00000X
Psychologist
Primary
880
LA
Other
Enumeration date
12/07/2006
Last updated
07/08/2007
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