Provider Demographics
NPI:1679038822
Name:PRUETT, ELIZABETH LYNNE (P-LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNNE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2391
Mailing Address - Country:US
Mailing Address - Phone:913-710-8810
Mailing Address - Fax:
Practice Address - Street 1:1310 CARONDELET DR STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4825
Practice Address - Country:US
Practice Address - Phone:816-753-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000938101YP2500X
MO201900938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty