Healthcare Provider Details

I. General information

NPI: 1891627873
Provider Name (Legal Business Name): RENEE PRUEITT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7484 UNIVERSITY AVE STE 220
LA MESA CA
91942-6030
US

IV. Provider business mailing address

7484 UNIVERSITY AVE STE 220
LA MESA CA
91942-6030
US

V. Phone/Fax

Practice location:
  • Phone: 619-248-9533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT163284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: