Provider Demographics
NPI:1588029706
Name:PRUITT, ARTHUR (LLPC)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:PRUITT
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3681
Mailing Address - Country:US
Mailing Address - Phone:269-323-1954
Mailing Address - Fax:
Practice Address - Street 1:40096 28TH AVE
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055-8614
Practice Address - Country:US
Practice Address - Phone:269-568-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015027101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)