Provider Demographics
NPI:1730552241
Name:FRAZIER, KRYSTAL SUZANNE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:SUZANNE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5808
Mailing Address - Country:US
Mailing Address - Phone:941-927-8900
Mailing Address - Fax:
Practice Address - Street 1:1750 17TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8632
Practice Address - Country:US
Practice Address - Phone:941-953-0000
Practice Address - Fax:941-954-0918
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health