Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | E1734 | OH |
NPI | 1003007790 |
---|---|
Provider Name | Mark Pruden |
First Address | Cincinnati, OH 45219-0971 |
Second Address | Cincinnati, OH 45219-1525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 23/04/2021 |