Provider Demographics
NPI:1538408018
Name:PRUEHS, VERLYNN RITCHIE (MS)
Entity type:Individual
Prefix:
First Name:VERLYNN
Middle Name:RITCHIE
Last Name:PRUEHS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 SHADY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4152
Mailing Address - Country:US
Mailing Address - Phone:909-953-3200
Mailing Address - Fax:
Practice Address - Street 1:44285 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4170
Practice Address - Country:US
Practice Address - Phone:661-341-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF72990106H00000X
CA87664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist