| Doctor Name: | MRS. TONI RENEE PRUSS |
| NPI Number: | 1023380268 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6301013605 |
| Business Practice Address: | 19401 Northline Rd Southgate, MI - 481952277 |
| Business Phone Number: | 7347857718 |
| Business Fax Number: | |
| Mailing Address: | 28773 Wales Dr, CHESTERFIELD |
| State: | MI |
| Postal Code: | 480471743 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/03/2012 |
| NPI Last Update Date: | 02/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301013605 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |