Provider Information for 1710032081
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Mrs. DEBRA PRUYN LCSW, QMHP
Sex: Female
NPI: 1710032081
Last Updated: 2019-05-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1710032081 | ||||||||||||
| Enumeration Date | 2007-01-24 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1215 SW G ST GRANTS PASS, OR 97526-2544 United States Phone: 541-476-2373 | Fax: | ||||||||||||
| Primary Practice Address | 1644 CARNAHAN DR GRANTS PASS, OR 97527-4724 United States Phone: 541-476-2373 | Fax: | ||||||||||||
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