Individual
DAVID JAMES FRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC I
Contact information
Practice address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15-04-21
OR
171M00000X
Case Manager/Care Coordinator
24-QMHA-R-4832
OR
175T00000X
Peer Specialist
23-CRM-2394
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500699844
—
OR
05
—
CGAC-RTG-22-097
—
OR
Enumeration date
06/17/2013
Last updated
01/19/2024
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