Healthcare Provider Details

I. General information

NPI: 1366709776
Provider Name (Legal Business Name): JOE L. PURVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 GREENO RD S
FAIRHOPE AL
36532-1916
US

IV. Provider business mailing address

372 GREENO RD S
FAIRHOPE AL
36532-1916
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-2871
  • Fax: 251-928-0126
Mailing address:
  • Phone: 251-928-2871
  • Fax: 251-928-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2234G
License Number StateAL

VIII. Authorized Official

Name: MR. JOE L PURVIS
Title or Position: ADULT IN-HOME THERAPIST
Credential: MSW, LGSW
Phone: 251-990-4214