Provider Demographics
NPI:1316015571
Name:PRUETT, FLORENCE CAROLE (LCSW LMFT DCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:CAROLE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:LCSW LMFT DCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 JORDAN ST STE 485
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4533
Mailing Address - Country:US
Mailing Address - Phone:318-424-5001
Mailing Address - Fax:318-424-5007
Practice Address - Street 1:820 JORDAN ST STE 485
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4533
Practice Address - Country:US
Practice Address - Phone:318-424-5001
Practice Address - Fax:318-424-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA920106H00000X
LA25911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5S064Medicare ID - Type Unspecified