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NPI Code Detail

MEDICARE: JARED PRYER LPC

MEDICARE: JARED PRYER LPC
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
1101YP2500XProfessional Counselor178.014510IL
2101YP2500XProfessional Counselor180.014463IL

General Provider Information

NPI Number : 1871067355
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED PRYER LPC
Provider Business Mailing Address
First Line : 210 S WASHINGTON ST
Second Line :
City : MC LEANSBORO
State : IL
Zip : 62859-1139
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 210 S WASHINGTON ST
Second Line :
City : MC LEANSBORO
State : IL
Zip : 62859-1139
Country : US
Telephone Number : 618-927-0478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 03/21/2023

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Directions to “ JARED PRYER LPC” Practice Location

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