Healthcare Provider Details

I. General information

NPI: 1033636428
Provider Name (Legal Business Name): SYDNEY PRUETT MCP, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY GREENWOOD

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S WALNUT ST
STILLWATER OK
74074-4222
US

IV. Provider business mailing address

604 S WALNUT ST
STILLWATER OK
74074-4222
US

V. Phone/Fax

Practice location:
  • Phone: 220-240-5372
  • Fax: 405-445-3780
Mailing address:
  • Phone: 220-240-5372
  • Fax: 405-445-3780

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: