Individual
MR. JEFFREY DAVID PRUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC, LCPC
Contact information
Practice address
1520 INDUSTRIAL AVE, VINITA, OK 74301-4803
(918) 256-7518
(918) 256-6771
Mailing address
27950 S HIGHWAY 125, UNIT 13-2, MONKEY ISLAND, OK 74331-3124
(913) 526-8643
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1035
KS
101YP2500X
Professional Counselor
2006038837
MO
101YP2500X
Professional Counselor
Primary
4871
OK
Other
Enumeration date
02/13/2007
Last updated
09/10/2012
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