Provider Demographics
NPI:1790803088
Name:PRYOR, LINDA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 DE GIVERVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1617
Mailing Address - Country:US
Mailing Address - Phone:314-727-6490
Mailing Address - Fax:
Practice Address - Street 1:5860 DE GIVERVILLE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-1617
Practice Address - Country:US
Practice Address - Phone:314-727-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000152570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional