| Doctor Name: | MISS AMY KATHLEEN PRUNEAU |
| NPI Number: | 1053603225 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LLP |
| License Number: | 6301014003 |
| Business Practice Address: | 260 Neptune Dr Walled Lake, MI - 483903661 |
| Business Phone Number: | 2488216485 |
| Business Fax Number: | |
| Mailing Address: | 260 Neptune Dr, WALLED LAKE |
| State: | MI |
| Postal Code: | 483903661 |
| Phone Number: | 2488216485 |
| Fax Number: | |
| NPI Enumeration Date: | 05/06/2011 |
| NPI Last Update Date: | 05/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 6301014003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |