Healthcare Provider Details

I. General information

NPI: 1295922979
Provider Name (Legal Business Name): DANIEL PRYOR MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43611 N 50TH DR
NEW RIVER AZ
85087-3088
US

IV. Provider business mailing address

43611 N 50TH DR
NEW RIVER AZ
85087-3088
US

V. Phone/Fax

Practice location:
  • Phone: 425-778-6169
  • Fax: 425-491-7491
Mailing address:
  • Phone: 425-778-6169
  • Fax: 425-491-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00003622
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: