MEDICARE: AUBREY SPYCE PRUITT MS, LPC CANDIDATE

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1811485162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY SPYCE PRUITT MS, LPC CANDIDATE

Provider Business Mailing Address
First Line	:	305 NW SHERIDAN RD STE C
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 NW SHERIDAN RD STE C
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6520
Country	:	US
Telephone Number	:	580-536-5102
Fax Number	:	580-536-5102

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

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	04/23/2018

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