Individual
MISTY CHANEL PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLMSW
Contact information
Practice address
3167 KALAMAZOO AVE SE STE 116, GRAND RAPIDS, MI 49508-1475
(630) 696-3204
Mailing address
3167 KALAMAZOO AVE SE STE 116, GRAND RAPIDS, MI 49508-1475
(630) 696-3204
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6851121165
MI
Other
Enumeration date
12/19/2025
Last updated
12/19/2025
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