Individual
MRS. DEBRA PRUYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, QMHP
Contact information
Practice address
1644 CARNAHAN DR, GRANTS PASS, OR 97527-4724
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
052056-1
NY
1041C0700X
Clinical Social Worker
Primary
L8013
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02074697
—
NY
Enumeration date
01/24/2007
Last updated
05/01/2019
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