Provider Demographics
NPI:1568513570
Name:PRUITT, MELISSA RENEE (MS, LIMHP, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:MS, LIMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1246
Mailing Address - Country:US
Mailing Address - Phone:402-968-7352
Mailing Address - Fax:402-944-2867
Practice Address - Street 1:12035 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3542
Practice Address - Country:US
Practice Address - Phone:402-991-0611
Practice Address - Fax:402-991-6228
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1897101YM0800X
NE3447101YM0800X
NE3819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025692300Medicaid