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NPI Code Detail

MEDICARE: AMANDA G PRUIT LPC

MEDICARE: AMANDA G PRUIT LPC
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
1101Y00000XCounselor76198TX
2101Y00000XCounselor2012014720MO

General Provider Information

NPI Number : 1861756819
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA G PRUIT LPC
Provider Business Mailing Address
First Line : 320 NORTH ST STE 206
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-5018
Country : US
Telephone Number : 936-244-5681
Fax Number :
Provider Business Practice Location Address
First Line : 320 NORTH ST STE 206
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-5018
Country : US
Telephone Number : 936-244-5681
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2012
Last Update Date : 07/10/2023

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