Healthcare Provider Details

I. General information

NPI: 1487922969
Provider Name (Legal Business Name): RHONDA LEE PRUITT LPC, LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 E WINTER DR
PHOENIX AZ
85020-4213
US

IV. Provider business mailing address

1223 E WINTER DR
PHOENIX AZ
85020-4213
US

V. Phone/Fax

Practice location:
  • Phone: 602-320-7787
  • Fax:
Mailing address:
  • Phone: 602-320-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberF18635
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1291
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11597
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: