Provider Demographics
NPI:1457331233
Name:PRUYT-MILLERBERG, PAMELA JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JOY
Last Name:PRUYT-MILLERBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:JOY
Other - Last Name:PRUYT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8138 ANGEL ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0350
Mailing Address - Country:US
Mailing Address - Phone:801-558-9982
Mailing Address - Fax:
Practice Address - Street 1:9361 S 300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2902
Practice Address - Country:US
Practice Address - Phone:801-826-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141079-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU006OtherINTRMTN. HEALTH CARE
UTU003OtherEDUCATORS MUTUAL
UTU002OtherDESERET MUTUAL
UTU000077078Medicare PIN