Provider Demographics
NPI:1437610565
Name:PRUITT, SARAH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MELCHIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1010 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2019
Mailing Address - Country:US
Mailing Address - Phone:541-791-1793
Mailing Address - Fax:833-770-4969
Practice Address - Street 1:1010 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2019
Practice Address - Country:US
Practice Address - Phone:541-791-1793
Practice Address - Fax:833-770-4969
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR11152104100000X
ORA55491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11152OtherOREGON STATE BOARD OF LICENSED SOCIAL WORKERS
ORA5549OtherOREGON STATE BOARD OF LICENSED SOCIAL WORKERS