Individual
FRED PRINDAVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
210 W 21ST ST, CONCORDIA, KS 66901-5200
(785) 243-8900
(785) 243-8933
Mailing address
PO BOX 747, MANHATTAN, KS 66505-0747
(785) 587-4300
(785) 587-4377
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0487
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11654639
CAQH
—
01
—
119780
BCBS
KS
05
—
200440650A
—
KS
Enumeration date
06/14/2006
Last updated
01/22/2013
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