Provider Demographics
NPI:1376708271
Name:PRYOR, SAMANTHA LEE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEE
Last Name:PRYOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-1451
Mailing Address - Country:US
Mailing Address - Phone:918-617-2845
Mailing Address - Fax:918-452-3939
Practice Address - Street 1:RR 1 BOX 131C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-9223
Practice Address - Country:US
Practice Address - Phone:918-452-3133
Practice Address - Fax:918-452-3939
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical