Provider Demographics
NPI:1053125732
Name:PRUITT, JASMINE (RBT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 SAND CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1596
Mailing Address - Country:US
Mailing Address - Phone:219-359-3272
Mailing Address - Fax:
Practice Address - Street 1:53779 GENERATIONS DR STE C
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1577
Practice Address - Country:US
Practice Address - Phone:219-359-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician