Provider Demographics
NPI:1548494354
Name:FRIESEN, JAMES GORDON
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GORDON
Last Name:FRIESEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 BALBOA BL.
Mailing Address - Street 2:#538
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-893-4463
Mailing Address - Fax:
Practice Address - Street 1:11145 TAMPA AVE
Practice Address - Street 2:SUITE 23A
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326
Practice Address - Country:US
Practice Address - Phone:818-893-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL70180OtherBLUE SHIELD PIN #