Provider Demographics
NPI:1386882959
Name:PRATT, PRISCILLA (LPC, CRC)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9513 ROLAN MEADOWS LANE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111
Mailing Address - Country:US
Mailing Address - Phone:313-283-1639
Mailing Address - Fax:
Practice Address - Street 1:8623 N HALL RD
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1137
Practice Address - Country:US
Practice Address - Phone:734-749-8490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2019-07-05
Deactivation Date:2010-02-26
Deactivation Code:
Reactivation Date:2017-06-15
Provider Licenses
StateLicense IDTaxonomies
MI6401007457101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor