MEDICARE: CHRISTIN K PRYOR PHD,LPC, LMFT

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	101YP2500X	Professional Counselor	2004030704	MO

General Provider Information

NPI Number	:	1922287473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIN K PRYOR PHD,LPC, LMFT

Provider Business Mailing Address
First Line	:	9904 OLD WARSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1030
Country	:	US
Telephone Number	:	314-853-6805
Fax Number	:	314-909-9382

Provider Business Practice Location Address
First Line	:	7292 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-2438
Country	:	US
Telephone Number	:	314-853-6805
Fax Number	:	314-909-9382

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	10/05/2010

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