Provider Demographics
NPI:1750673109
Name:PRYOR-JOHNSON, SUSAN (MSE, LIMHP, LADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:PRYOR-JOHNSON
Suffix:
Gender:F
Credentials:MSE, LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5122
Mailing Address - Country:US
Mailing Address - Phone:402-370-4208
Mailing Address - Fax:402-370-4208
Practice Address - Street 1:305 N 9TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3915
Practice Address - Country:US
Practice Address - Phone:402-379-3622
Practice Address - Fax:402-644-4593
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE717101YA0400X
NE2962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)