Provider Demographics
NPI:1174099030
Name:PRUS, CHRISTOPHER (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:PRUS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BISHOP AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2346
Mailing Address - Country:US
Mailing Address - Phone:860-302-7655
Mailing Address - Fax:
Practice Address - Street 1:969 W MAIN ST STE 1D
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2667
Practice Address - Country:US
Practice Address - Phone:203-768-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3556101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional