Healthcare Provider Details

I. General information

NPI: 1205575248
Provider Name (Legal Business Name): RICHARD PRYOR LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 7TH ST
MERIDIAN MS
39301-4851
US

IV. Provider business mailing address

2827 7TH ST
MERIDIAN MS
39301-4851
US

V. Phone/Fax

Practice location:
  • Phone: 601-527-2890
  • Fax:
Mailing address:
  • Phone: 601-527-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5284C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4201
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: