Provider Demographics
NPI:1275552184
Name:PRYOR, MARTHA ANDERSON (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANDERSON
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5310 WARD ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1829
Mailing Address - Country:US
Mailing Address - Phone:877-838-4783
Mailing Address - Fax:888-617-8611
Practice Address - Street 1:4639 NEWCOM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5131
Practice Address - Country:US
Practice Address - Phone:865-558-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP295TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3691813Medicare PIN