Provider Demographics
NPI:1326480161
Name:PRUITT-LANPHERE, LYN (LPC)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:
Last Name:PRUITT-LANPHERE
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 1:127 VINEYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7105
Mailing Address - Country:US
Mailing Address - Phone:769-241-5229
Mailing Address - Fax:
Practice Address - Street 1:361 TOWNE CENTER PL STE 1300
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4866
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional