Healthcare Provider Details

I. General information

NPI: 1972748739
Provider Name (Legal Business Name): DAMON L PRATT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-8040
  • Fax:
Mailing address:
  • Phone: 314-590-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: