Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003023573 |
---|---|
Provider Name | Miss Amber Linnise Purcell |
First Address | Pine Bluff, AR 71603-3937 |
Second Address | Stuttgart, AR 72160-7033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 28/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116378726 | (05) | AR |