Provider Demographics
NPI:1831488345
Name:PRY, SAMUALLA L (LSW,)
Entity Type:Individual
Prefix:MS
First Name:SAMUALLA
Middle Name:L
Last Name:PRY
Suffix:
Gender:F
Credentials:LSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S STEWART ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5251
Mailing Address - Country:US
Mailing Address - Phone:775-684-7012
Mailing Address - Fax:775-684-7026
Practice Address - Street 1:901 S STEWART ST STE 1001
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5251
Practice Address - Country:US
Practice Address - Phone:775-684-7012
Practice Address - Fax:775-684-7026
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4872-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker