Provider Demographics
NPI:1043089451
Name:PRUIETT, TALIA ONAY
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:ONAY
Last Name:PRUIETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20307 WESTOVER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7952
Mailing Address - Country:US
Mailing Address - Phone:989-415-0843
Mailing Address - Fax:
Practice Address - Street 1:29200 NORTHWESTERN HWY STE 110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1055
Practice Address - Country:US
Practice Address - Phone:989-415-0843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker