Healthcare Provider Details

I. General information

NPI: 1942652607
Provider Name (Legal Business Name): JOHN C PRYOR LCPC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 E DOUGLAS AVE STE 150
WICHITA KS
67218-1032
US

IV. Provider business mailing address

117 S LEXINGTON ST STE 100
HARRISONVILLE MO
64701-2444
US

V. Phone/Fax

Practice location:
  • Phone: 816-533-5041
  • Fax:
Mailing address:
  • Phone: 816-533-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2016029692
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC03946
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2016029692
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: