Provider Demographics
NPI:1881118875
Name:PRYOR, AMANDA D (LCPC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:D
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 W STONEGATE BLVD APT 814
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1067
Mailing Address - Country:US
Mailing Address - Phone:773-757-3539
Mailing Address - Fax:
Practice Address - Street 1:3400 W STONEGATE BLVD APT 814
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1067
Practice Address - Country:US
Practice Address - Phone:773-757-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010323101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional