Provider Demographics
NPI:1578092912
Name:PRUETT, RHONDA GAYE
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:GAYE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 STATE HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73051-6211
Mailing Address - Country:US
Mailing Address - Phone:417-293-1117
Mailing Address - Fax:
Practice Address - Street 1:16601 ST HWY 39
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OK
Practice Address - Zip Code:73051
Practice Address - Country:US
Practice Address - Phone:417-293-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health