Healthcare Provider Details

I. General information

NPI: 1003768045
Provider Name (Legal Business Name): RUTH ESTHER PRUITT RMHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 OAK ST
GREEN COVE SPRINGS FL
32043-4313
US

IV. Provider business mailing address

623 OAK ST
GREEN COVE SPRINGS FL
32043-4313
US

V. Phone/Fax

Practice location:
  • Phone: 904-531-9752
  • Fax: 904-531-5149
Mailing address:
  • Phone: 904-531-9752
  • Fax: 904-531-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: