Provider Demographics
NPI:1376043232
Name:WANDEE J. PRYOR, PSY.D., LLC
Entity Type:Organization
Organization Name:WANDEE J. PRYOR, PSY.D., LLC
Other - Org Name:WANDEE J. PRYOR, PSY.D., LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDEE
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:646-418-2652
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0197
Mailing Address - Country:US
Mailing Address - Phone:360-697-1141
Mailing Address - Fax:
Practice Address - Street 1:20174 FRONT ST NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7445
Practice Address - Country:US
Practice Address - Phone:360-607-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60412791261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)