Individual
BETHANY PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
3142 MALLARD COVE LN, FORT WAYNE, IN 46804-2882
(260) 409-7073
Mailing address
3142 MALLARD COVE LN, FORT WAYNE, IN 46804-2882
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34008242A
IN
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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