Provider Demographics
NPI:1578035069
Name:FRY, JESSICA RAE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RAE
Last Name:FRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:440A GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-1178
Mailing Address - Country:US
Mailing Address - Phone:570-241-7221
Mailing Address - Fax:
Practice Address - Street 1:5570 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3517
Practice Address - Country:US
Practice Address - Phone:717-525-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010966101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional