Individual
RYAN GLYN PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
601 VISTA LN TRLR 44, EDMOND, OK 73034-6367
(405) 532-7674
Mailing address
601 VISTA LN TRLR 44, EDMOND, OK 73034-6367
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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