Provider Demographics
NPI:1093863177
Name:PRUM, LAY (NONE)
Entity Type:Individual
Prefix:MR
First Name:LAY
Middle Name:
Last Name:PRUM
Suffix:
Gender:M
Credentials:NONE
Other - Prefix:MR
Other - First Name:LAY
Other - Middle Name:
Other - Last Name:PRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:2211 NORTH FINE STREET
Mailing Address - Street 2:2211 NORTH FINE STREET
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1529
Mailing Address - Country:US
Mailing Address - Phone:559-455-2175
Mailing Address - Fax:559-455-2087
Practice Address - Street 1:2211 NORTH FINE STREET
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1529
Practice Address - Country:US
Practice Address - Phone:559-455-2093
Practice Address - Fax:559-455-2087
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health