Samuel Preylo Jr., PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2008034858 Issued in MO

Practice address

600 Caisson Hill Rd
Fort Riley, KS 66442-7037

Phone

(785) 239-7000

NPI assigned

Mar 15, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northwest Behavioral Health Consultants, LLC

  • Clinical Psychologist
  • Chillicothe, MO
  • NPI 1366776304
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1669506283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 FAIRWAY DR.",
            "city": "CHILLICOTHE",
            "state": "MO",
            "postal_code": "646012019",
            "telephone_number": "660-646-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 CAISSON HILL RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664427037",
            "telephone_number": "785-239-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREYLO",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2004014038",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2008034858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494908205",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Potvin, RD, LD, CLC
• Tamekia Pough, OT
• Sean M. Pozarek, CRNA
• Kariga Karim Pratt, LCSW, LCAC
• Jennifer A Prewitt, PSY.D.
• Sally A Prickett, CNM
• Rachel L Prokop, PSY.D.
• Doris J Rak, ARNP
• Vanessa Johan Ramirez, DPT
• Lauryn B Rankin, DPT

• Clinical Psychologist in Fort Riley, KS
• Providers in Fort Riley, KS by specialty
• Clinical Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.