Provider Demographics
NPI:1033636428
Name:PRUETT, SYDNEY (MCP, LPC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:PRUETT
Suffix:
Gender:F
Credentials:MCP, LPC
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4222
Mailing Address - Country:US
Mailing Address - Phone:220-240-5372
Mailing Address - Fax:405-445-3780
Practice Address - Street 1:604 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4222
Practice Address - Country:US
Practice Address - Phone:220-240-5372
Practice Address - Fax:405-445-3780
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200323940Medicaid