Provider Demographics
NPI:1003007790
Name:PRUDEN, MARK (LPCC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PRUDEN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19971
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-0971
Mailing Address - Country:US
Mailing Address - Phone:513-861-6543
Mailing Address - Fax:513-381-0016
Practice Address - Street 1:42 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1525
Practice Address - Country:US
Practice Address - Phone:513-861-6543
Practice Address - Fax:513-381-0016
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional