Provider Demographics
NPI:1518384312
Name:PRUITT, ANEIKA (MA, LPC-S, LCDC)
Entity Type:Individual
Prefix:
First Name:ANEIKA
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:MA, LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77284-0104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11999 KATY FWY STE 150R
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1604
Practice Address - Country:US
Practice Address - Phone:713-702-4747
Practice Address - Fax:832-698-9555
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12371101YA0400X
TX69319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330534404Medicaid