Provider Demographics
NPI:1396087920
Name:PRYOR, AMANDA J (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4323
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1034
Mailing Address - Country:US
Mailing Address - Phone:812-231-8200
Mailing Address - Fax:812-231-8400
Practice Address - Street 1:1200 N. 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-0553
Practice Address - Country:US
Practice Address - Phone:812-847-4435
Practice Address - Fax:812-847-8297
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007346A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical