Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | A1103025 | AR |
NPI | 1003110420 |
---|---|
Provider Name | Joshua Pursifull |
First Address | Batesville, AR 72503-2578 |
Second Address | Heber Springs, AR 72543-3532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2010 |
Last Update Date | 18/03/2011 |