Elton Michael Priddy, LCPC

Key facts

NPI

1366587016

Entity type

Individual (NPI type 1)

Primary specialty

Professional Counselor 101YP2500X

License

229 (KS)

Practice address

12400 W 62ND Ter
Suite G
Shawnee, KS 66216-1833

Phone

(913) 449-3696

Fax

(913) 548-4816

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other names

• Mr. E. Michael Priddy Professional name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 28, 2010.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272412800000",
    "number": "1366587016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24131",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662834131",
            "telephone_number": "913-449-3696",
            "fax_number": "913-548-4816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 W 62ND TER",
            "address_2": "SUITE G",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662161833",
            "telephone_number": "913-449-3696",
            "fax_number": "913-548-4816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDDY",
        "first_name": "ELTON",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2010-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KS",
            "license": "229",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2002008095",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "E.",
            "last_name": "PRIDDY",
            "middle_name": "MICHAEL",
            "prefix": "MR.",
            "credential": "LCPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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