Healthcare Provider Details

I. General information

NPI: 1336652106
Provider Name (Legal Business Name): SANDRA GAIL PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LOUISIANA AVE
FERRIDAY LA
71334-2826
US

IV. Provider business mailing address

128 LOUISIANA AVE
FERRIDAY LA
71334-2826
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-7157
  • Fax: 318-323-1400
Mailing address:
  • Phone: 318-757-7157
  • Fax: 318-323-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: