Provider Demographics
NPI:1396801957
Name:PRUITT, STANLEY JAMAR
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:JAMAR
Last Name:PRUITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5632
Mailing Address - Country:US
Mailing Address - Phone:619-370-8544
Mailing Address - Fax:480-641-5768
Practice Address - Street 1:3707 E SOUTHERN AVE STE 1051
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6205
Practice Address - Country:US
Practice Address - Phone:480-493-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child