Basic Information
| Provider Information | |||||||||
| NPI: | 1649513417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURCELL | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PC, CFLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 S HOLLAND SYLVANIA RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436155713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193046895 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | JOBST TOWER, SUITE 640 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5676610505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2013 | ||||||||
| LastUpdateDate: | 03/31/2013 | ||||||||
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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 | C.1100246 | OH | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.