Healthcare Provider Details

I. General information

NPI: 1538078449
Provider Name (Legal Business Name): EVAN CHAINEY EVANS PRUETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GLOVER AVE STE 3
ENTERPRISE AL
36330-2070
US

IV. Provider business mailing address

639 FREEDOM DR APT H105
ENTERPRISE AL
36330-0708
US

V. Phone/Fax

Practice location:
  • Phone: 334-308-2292
  • Fax:
Mailing address:
  • Phone: 334-763-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: