Provider Demographics
NPI:1992226682
Name:PRYOR, KELLIE (LCMHC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:PRYOR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 JASMINE SPUR
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2504
Mailing Address - Country:US
Mailing Address - Phone:704-928-7232
Mailing Address - Fax:
Practice Address - Street 1:5652 JASMINE SPUR
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2504
Practice Address - Country:US
Practice Address - Phone:704-928-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor