Provider Demographics
NPI:1144527300
Name:PRUITT-HAMM, JANIS (MA, LMHC)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:PRUITT-HAMM
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2447
Mailing Address - Country:US
Mailing Address - Phone:186-661-1169
Mailing Address - Fax:509-685-1231
Practice Address - Street 1:1231B MINGO MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:KETTLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99141-9704
Practice Address - Country:US
Practice Address - Phone:509-230-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00006329OtherLICENSED MENTAL HEALTH COUNSELOR