Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1023315645 |
---|---|
Provider Name | Troy Mathew Purdom |
First Address | Paradise, CA 95969-3280 |
Second Address | Paradise, CA 95969-3280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 16/02/2011 |