Provider Demographics
NPI:1952315244
Name:PRIFOGLE, TONYA LYNN (MA, NCC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:LYNN
Last Name:PRIFOGLE
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
Other - Prefix:MISS
Other - First Name:TONYA
Other - Middle Name:LYNN
Other - Last Name:ALESHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4622
Practice Address - Country:US
Practice Address - Phone:765-453-8555
Practice Address - Fax:765-453-8021
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001694A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INALESH-0010OtherCOMPCARE ID NUMBER
IN000000376879OtherANTHEM BX/BS ID NUMBER
IN11513250OtherCAQH ID NUMBER