MEDICARE: ANEIKA PRUITT MA, LPC-S, LCDC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12371	TX
2	101YP2500X	Professional Counselor	69319	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518384312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANEIKA PRUITT MA, LPC-S, LCDC

Provider Business Mailing Address
First Line	:	PO BOX 840104
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77284-0104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11999 KATY FWY STE 150R
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-1604
Country	:	US
Telephone Number	:	713-702-4747
Fax Number	:	832-698-9555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	12/05/2020

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