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NPI Code Detail

MEDICARE: JEAN F PRUETT LPC

MEDICARE: JEAN F PRUETT LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor4663NC

General Provider Information

NPI Number : 1952420796
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN F PRUETT LPC
Provider Business Mailing Address
First Line : PO BOX 30279
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27130-0279
Country : US
Telephone Number : 336-922-1102
Fax Number :
Provider Business Practice Location Address
First Line : 3734 REYNOLDA RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-2240
Country : US
Telephone Number : 336-922-1102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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Directions to “ JEAN F PRUETT LPC” Practice Location

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