Provider Demographics
NPI:1316560303
Name:AMY K PRUNEAU LLC
Entity Type:Organization
Organization Name:AMY K PRUNEAU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:PRUNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-821-6485
Mailing Address - Street 1:27655 MIDDLEBELT RD STE 140
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5029
Mailing Address - Country:US
Mailing Address - Phone:248-821-6485
Mailing Address - Fax:
Practice Address - Street 1:26755 MIDDLEBELT RD STE 140
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-821-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-25
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty