Provider Demographics
NPI:1699269514
Name:PRUITT, ASHLEY RANAE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RANAE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10599 N TATUM BLVD STE F153
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1053
Mailing Address - Country:US
Mailing Address - Phone:602-606-2237
Mailing Address - Fax:
Practice Address - Street 1:10599 N TATUM BLVD STE F153
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1053
Practice Address - Country:US
Practice Address - Phone:602-606-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000355103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst