Provider Demographics
NPI:1255542783
Name:PRUETT, MICHELLE THOMAS (LPC, MED, EDS)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:THOMAS
Last Name:PRUETT
Suffix:
Gender:F
Credentials:LPC, MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OFFICE PARK CIR STE 220
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2535
Mailing Address - Country:US
Mailing Address - Phone:205-912-2006
Mailing Address - Fax:205-912-2006
Practice Address - Street 1:3 OFFICE PARK CIR STE 220
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2535
Practice Address - Country:US
Practice Address - Phone:205-912-2006
Practice Address - Fax:205-912-2006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2443101Y00000X
TN1892101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor