Provider Demographics
NPI:1902802341
Name:PRY, RICHARD MCLELLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MCLELLAN
Last Name:PRY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1949
Mailing Address - Country:US
Mailing Address - Phone:724-325-2229
Mailing Address - Fax:724-327-3176
Practice Address - Street 1:4345 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1949
Practice Address - Country:US
Practice Address - Phone:724-325-2229
Practice Address - Fax:724-327-3176
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-12-23
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
PAPS003475L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist