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NPI Code Detail

MEDICARE: MS. MICHELLE THOMAS PRUETT LPC, M.ED., ED.S.

MEDICARE: MS. MICHELLE THOMAS PRUETT LPC, M.ED., ED.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor2443AL
2101Y00000XCounselor1892TN

General Provider Information

NPI Number : 1255542783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE THOMAS PRUETT LPC, M.ED., ED.S.
Provider Business Mailing Address
First Line : 3 OFFICE PARK CIR STE 220
Second Line :
City : MOUNTAIN BRK
State : AL
Zip : 35223-2535
Country : US
Telephone Number : 205-912-2006
Fax Number : 205-912-2006
Provider Business Practice Location Address
First Line : 3 OFFICE PARK CIR STE 220
Second Line :
City : MOUNTAIN BRK
State : AL
Zip : 35223-2535
Country : US
Telephone Number : 205-912-2006
Fax Number : 205-912-2006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 09/22/2020

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