Provider Demographics
NPI:1669860169
Name:PRITCHARD, CARRIE LYNNE (PHD, LBA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:PHD, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WAKEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1552
Mailing Address - Country:US
Mailing Address - Phone:270-935-5119
Mailing Address - Fax:270-935-5109
Practice Address - Street 1:705 WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1552
Practice Address - Country:US
Practice Address - Phone:270-935-5119
Practice Address - Fax:270-935-5109
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163008103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100332420Medicaid
KY163008OtherLICENSE