Provider Demographics
NPI:1801541818
Name:PRUITT, BROOKE (LMHCA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38304 ALLEN RD S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-9129
Mailing Address - Country:US
Mailing Address - Phone:808-398-5992
Mailing Address - Fax:
Practice Address - Street 1:3905 MARTIN WAY E STE D1
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98506-5284
Practice Address - Country:US
Practice Address - Phone:360-200-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61233688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health