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General NPI Number Information
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NPI Number | 1295611374
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Entity Type | Individual
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Provider Name | DENNIS M PRUITT SR.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 390 THOMAS ST
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City | ATOKA
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State | TN
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Zip | 38004-7172
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Country | US
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Telephone | 901-900-0281
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Fax |
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Provider Business Mailing Address
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Address Line | 390 THOMAS ST
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City | ATOKA
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State | TN
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Zip | 38004-7172
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Country | US
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Telephone | 901-900-0281
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 4492
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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