Provider Demographics
NPI:1467458158
Name:PRUETZEL, SHARON S (MS, LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:PRUETZEL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:S
Other - Last Name:LOGSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 HIGHLANDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HALLTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:65664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1013 HIGHLANDVILLE RD
Practice Address - Street 2:
Practice Address - City:HALLTOWN
Practice Address - State:MO
Practice Address - Zip Code:65664
Practice Address - Country:US
Practice Address - Phone:417-761-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495696502Medicaid