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General NPI Number Information
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NPI Number | 1174099030
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Entity Type | Individual
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Provider Name | CHRISTOPHER PRUS LPC
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Gender | Male
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 969 W MAIN ST STE 1D
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City | WATERBURY
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State | CT
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Zip | 06708-2667
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Country | US
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Telephone | 203-768-9808
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Fax |
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Provider Business Mailing Address
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Address Line | 112 BISHOP AVE
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2346
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Country | US
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Telephone | 860-302-7655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3556
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License Number State | CT
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