Provider Demographics
NPI:1902983588
Name:PRIDDY, JAN E (LPC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:PRIDDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 GARDNER ST # A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4965
Mailing Address - Country:US
Mailing Address - Phone:907-301-4067
Mailing Address - Fax:
Practice Address - Street 1:1825 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5391
Practice Address - Country:US
Practice Address - Phone:907-522-7080
Practice Address - Fax:907-522-7088
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK479OtherALASKA STATE LICENSE