Provider Demographics
NPI:1275705634
Name:PRUITT, JENNIFER ELLEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:PRUITT
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 1:1210 STONEHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2033
Mailing Address - Country:US
Mailing Address - Phone:281-358-4633
Mailing Address - Fax:281-358-5124
Practice Address - Street 1:1210 STONEHOLLOW DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2033
Practice Address - Country:US
Practice Address - Phone:281-358-4633
Practice Address - Fax:281-358-5124
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional