Basic Information
| Provider Information | |||||||||
| NPI: | 1316584246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS PRYOR | ||||||||
| FirstName: | TONI | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| OtherLastName: | EVANS | ||||||||
| OtherFirstName: | TONI | ||||||||
| OtherMiddleName: | ANNETTE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | TONI EVANS PRYOR | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1400 N JOHNSON AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920201651 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1180 THIRD AVE STE C3 | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919113139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196918164 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2019 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.