Provider Demographics
NPI:1548668635
Name:FRY, DANIEL T KAEL (MS, MFT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T KAEL
Last Name:FRY
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-1601
Mailing Address - Country:US
Mailing Address - Phone:608-234-8763
Mailing Address - Fax:
Practice Address - Street 1:202 S BLACK AVE
Practice Address - Street 2:STE 602
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6246
Practice Address - Country:US
Practice Address - Phone:608-234-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-MFLC-LIC-20680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist