MEDICARE: MRS. AMANDA D. PRYOR LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.010323	IL
2	101YM0800X	Mental Health Counselor	180.010323	IL

General Provider Information

NPI Number	:	1881118875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA D. PRYOR LCPC

Provider Business Mailing Address
First Line	:	3400 W STONEGATE BLVD APT 814
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1067
Country	:	US
Telephone Number	:	773-757-3539
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 W STONEGATE BLVD APT 814
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1067
Country	:	US
Telephone Number	:	773-757-3539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	02/18/2021

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