Provider Demographics
NPI:1316157811
Name:PRUITT, AMY ELIZABETH (LMFT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELIZABETH
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:LAFLEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1002 39TH AVE SW STE 208
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3805
Mailing Address - Country:US
Mailing Address - Phone:253-317-1737
Mailing Address - Fax:253-697-3730
Practice Address - Street 1:1002 39TH AVE SW STE 208
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3805
Practice Address - Country:US
Practice Address - Phone:253-317-1737
Practice Address - Fax:253-697-3730
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60950866101Y00000X
106H00000X
OR101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663797Medicaid