Kenneth Lamar Prust, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6795-123 Issued in WI

Practice address

1200 N Center St
Beaver Dam, WI 53916-1148

Phone

(920) 887-3171

Fax

(920) 887-8662

NPI assigned

Sep 6, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1134113178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N7377 MALIBOU LN",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539169534",
            "telephone_number": "920-887-2517",
            "fax_number": "920-887-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N CENTER ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161148",
            "telephone_number": "920-887-3171",
            "fax_number": "920-887-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUST",
        "first_name": "KENNETH",
        "middle_name": "LAMAR",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "6795-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43579800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.