Provider Demographics
NPI:1083093959
Name:PRUTER, SHERRY K (LPC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:K
Last Name:PRUTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SE 1 AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-9696
Mailing Address - Country:US
Mailing Address - Phone:620-786-7105
Mailing Address - Fax:
Practice Address - Street 1:155 SE 1 AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-9696
Practice Address - Country:US
Practice Address - Phone:620-786-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health