Provider Demographics
NPI:1871324657
Name:PRYTHERCH, ALEXIS BREANNA
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BREANNA
Last Name:PRYTHERCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S SPRINGDALE ST APT 304
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-7323
Mailing Address - Country:US
Mailing Address - Phone:316-807-2757
Mailing Address - Fax:
Practice Address - Street 1:2701 S SPRINGDALE ST APT 304
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-7323
Practice Address - Country:US
Practice Address - Phone:316-807-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician