Provider Demographics
NPI:1407831571
Name:PRUETT, JEAN S (DMIN, LPC, HTCP/I)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:S
Last Name:PRUETT
Suffix:
Gender:F
Credentials:DMIN, LPC, HTCP/I
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:664 W HEATHERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2787
Mailing Address - Country:US
Mailing Address - Phone:704-651-2895
Mailing Address - Fax:864-574-8142
Practice Address - Street 1:664 W HEATHERSTONE LN
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2787
Practice Address - Country:US
Practice Address - Phone:704-651-2895
Practice Address - Fax:864-574-8142
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLPC 1762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional