person
Kenneth Lamar Prust, LCSW
Mental Health Counselor in Beaver Dam, Wisconsin
NPI 1134113178

Kenneth Lamar Prust is a Mental Health Counselor based in Beaver Dam, WI and is specialized in Mental Health. Kenneth Lamar Prust practices in Beaver Dam, WI and has the professional credentials of LCSW. The NPI Number for Kenneth Lamar Prust is 1134113178 and holds a License No. 6795-123 (Wisconsin).

The current practice location address for Kenneth Lamar Prust is 1200 N Center St, Beaver Dam, WI and can be reached out via phone at 920-887-3171 and via fax at 920-887-8662.

Location: 1200 N Center St, Beaver Dam, WI, 53916-9534
person
Provider Profile Details
NPI Number
1134113178
Provider Name
Kenneth Lamar Prust
Credential
LCSW
Provider Entity Type
Individual
Gender
Male
Address
1200 N Center St, Beaver Dam, WI, 53916-9534
Phone Number
920-887-3171
Fax Number
920-887-8662
Provider Enumeration Date
09/06/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
43579800 05 WI
institution
Provider Business Practice Location Address Details
Address
1200 N Center St
City
State
Zip
53916-1148
Phone Number
920-887-3171
Fax Number
920-887-8662
person
Provider Business Mailing Address Details
Address
1200 N Center St
City
State
Zip
53916-1148
Phone Number
920-887-3171
Fax Number
920-887-8662
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
6795-123 (Wisconsin)
Definition
Definition to come...
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