MEDICARE: MARTHA ANDERSON PRYOR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IP295TN	TN

General Provider Information

NPI Number	:	1275552184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA ANDERSON PRYOR LCSW

Provider Business Mailing Address
First Line	:	5310 WARD ROAD
Second Line	:	SUITE 106
City	:	ARVADA
State	:	CO
Zip	:	80002-1829
Country	:	US
Telephone Number	:	877-838-4783
Fax Number	:	888-617-8611

Provider Business Practice Location Address
First Line	:	4639 NEWCOM AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5131
Country	:	US
Telephone Number	:	865-558-6499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/11/2008

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