Provider Demographics
NPI:1346576907
Name:PRYOR, KRISTEN C (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:C
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1619 W COLONIAL PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:IL
Mailing Address - Zip Code:60067-4732
Mailing Address - Country:US
Mailing Address - Phone:847-350-1303
Mailing Address - Fax:
Practice Address - Street 1:1619 W COLONIAL PKWY STE 109
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:IL
Practice Address - Zip Code:60067-4732
Practice Address - Country:US
Practice Address - Phone:847-350-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty