Healthcare Provider Details

I. General information

NPI: 1477060762
Provider Name (Legal Business Name): OLIVIA PRYOR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 S DAWSON ST STE 103
SEATTLE WA
98118-2100
US

IV. Provider business mailing address

2606 S 135TH ST
SEATAC WA
98168-3867
US

V. Phone/Fax

Practice location:
  • Phone: 206-408-2060
  • Fax:
Mailing address:
  • Phone: 831-747-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60823456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: