Healthcare Provider Details

I. General information

NPI: 1588029706
Provider Name (Legal Business Name): ARTHUR PRUITT LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40096 28TH AVE
GOBLES MI
49055-8614
US

IV. Provider business mailing address

625 HARRISON ST
KALAMAZOO MI
49007-3681
US

V. Phone/Fax

Practice location:
  • Phone: 269-568-0255
  • Fax:
Mailing address:
  • Phone: 269-323-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401015027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: