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Tony David Fredericks II
Peer Specialist in Elizabethtown, Kentucky
NPI 1174236624

Tony David Fredericks II is a Peer Specialist based in Elizabethtown, KY. Tony David Fredericks II practices in Elizabethtown, KY. The NPI Number for Tony David Fredericks II is 1174236624 and holds a License No. (Kentucky).

The current practice location address for Tony David Fredericks II is 100 Par Ln Ste 102, Elizabethtown, KY and can be reached out via phone at 270-312-2500.

Location: 100 Par Ln Ste 102, Elizabethtown, KY, 42701-9059
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1174236624
Provider Name
Tony David Fredericks II
Credential
Provider Entity Type
Individual
Gender
Male
Address
100 Par Ln Ste 102, Elizabethtown, KY, 42701-9059
Phone Number
270-312-2500
Fax Number
Provider Enumeration Date
12/29/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
100 Par Ln Ste 102
City
Elizabethtown
State
Kentucky
Zip
42701-9059
Phone Number
270-312-2500
Fax Number
person
Provider Business Mailing Address Details
Address
100 Par Ln Ste 102
City
Elizabethtown
State
Kentucky
Zip
42701-9059
Phone Number
270-312-2500
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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