Provider Demographics
NPI:1942652607
Name:PRYOR, JOHN C (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:PRYOR
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 FOXRIDGE DR APT 303
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4521
Mailing Address - Country:US
Mailing Address - Phone:573-280-1021
Mailing Address - Fax:
Practice Address - Street 1:5445 FOXRIDGE DR APT 303
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-4521
Practice Address - Country:US
Practice Address - Phone:573-280-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016029692101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490034981Medicaid