Healthcare Provider Details

I. General information

NPI: 1376708271
Provider Name (Legal Business Name): SAMANTHA LEE PRYOR M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 131C
EUFAULA OK
74432-9223
US

IV. Provider business mailing address

PO BOX 1440
EUFAULA OK
74432-1451
US

V. Phone/Fax

Practice location:
  • Phone: 918-452-3133
  • Fax: 918-452-3939
Mailing address:
  • Phone: 918-617-2845
  • Fax: 918-452-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2809
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: