Provider Demographics
NPI:1356969042
Name:FRYE, RENEE (CRM/CPSS)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:CRM/CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1694
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0095
Mailing Address - Country:US
Mailing Address - Phone:541-281-9330
Mailing Address - Fax:541-205-6000
Practice Address - Street 1:501 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6035
Practice Address - Country:US
Practice Address - Phone:541-281-9330
Practice Address - Fax:541-205-6000
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-CRM-268171400000X, 172V00000X, 175T00000X, 405300000X
174H00000X
ORNATIVE374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No405300000XOther Service ProvidersPrevention Professional