Basic Information
| Provider Information | |||||||||
| NPI: | 1487094439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURDY | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6833 STOCKTON BLVD STE 485 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958232376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163940800 | ||||||||
| FaxNumber: | 9164297824 | ||||||||
| Practice Location | |||||||||
| Address1: | 6833 STOCKTON BLVD STE 485 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958232376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163940800 | ||||||||
| FaxNumber: | 9164297824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2013 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.