Provider Demographics
NPI:1255680492
Name:PRUETT, STEVEN R (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:PRUETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 WINDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6321
Mailing Address - Country:US
Mailing Address - Phone:614-668-2588
Mailing Address - Fax:
Practice Address - Street 1:4985 SEARLS DR NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7464
Practice Address - Country:US
Practice Address - Phone:330-966-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical