Provider Demographics
NPI:1417737370
Name:PRUITT, BRITTANY PAIGE (ME)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:PAIGE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1915
Mailing Address - Country:US
Mailing Address - Phone:251-421-2247
Mailing Address - Fax:
Practice Address - Street 1:1157 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6007
Practice Address - Country:US
Practice Address - Phone:251-421-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist