Doctor Name: | MARY LOUISE PRUETT |
NPI Number: | 1053385187 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 34004128 |
Business Practice Address: | 7 E Hendricks St Shelbyville, IN - 461762124 |
Business Phone Number: | 3173922564 |
Business Fax Number: | |
Mailing Address: | 8180 Clearvista Pkwy, 230 INDIANAPOLIS |
State: | IN |
Postal Code: | 462565629 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 34004128 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |