Provider Demographics
NPI:1477060762
Name:PRYOR, OLIVIA (LMHC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 S 135TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3867
Mailing Address - Country:US
Mailing Address - Phone:831-747-4690
Mailing Address - Fax:
Practice Address - Street 1:5100 S DAWSON ST STE 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2100
Practice Address - Country:US
Practice Address - Phone:206-408-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60823456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional