Individual
MARY MOLLY LOREN PRUIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3425 W CENTRAL AVE, WICHITA, KS 67203-4919
(316) 946-0990
(316) 943-1139
Mailing address
3425 W CENTRAL AVE, WICHITA, KS 67203-4919
(316) 946-0990
(316) 943-1139
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2240
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070415
BCBS
KS
05
—
100457290B
—
KS
Enumeration date
05/01/2006
Last updated
10/22/2013
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