Healthcare Provider Details

I. General information

NPI: 1144527300
Provider Name (Legal Business Name): JANIS PRUITT-HAMM MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231B MINGO MOUNTAIN RD
KETTLE FALLS WA
99141-9704
US

IV. Provider business mailing address

298 S MAIN ST
COLVILLE WA
99114-2447
US

V. Phone/Fax

Practice location:
  • Phone: 509-230-6575
  • Fax:
Mailing address:
  • Phone: 186-661-1169
  • Fax: 509-685-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00006329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: