Provider Demographics
NPI:1528829637
Name:FRALEY, CLYDE (LMFT)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:
Last Name:FRALEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SPECKLED WOODS PL
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-1502
Mailing Address - Country:US
Mailing Address - Phone:183-233-4919
Mailing Address - Fax:
Practice Address - Street 1:9391 GROGANS MILL RD STE A5
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3628
Practice Address - Country:US
Practice Address - Phone:936-217-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty