Provider Demographics
NPI:1356808398
Name:PRUITT, RICHARD MICHAEL (RBT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:PRUITT
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROMERO ST NW # A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1421
Mailing Address - Country:US
Mailing Address - Phone:505-933-1033
Mailing Address - Fax:
Practice Address - Street 1:415 ROMERO ST NW # A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1421
Practice Address - Country:US
Practice Address - Phone:505-933-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician