Healthcare Provider Details

I. General information

NPI: 1700242583
Provider Name (Legal Business Name): CHERYL PURDUE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12444 VENTURA BLVD STE 206
STUDIO CITY CA
91604-2409
US

IV. Provider business mailing address

12444 VENTURA BLVD STE 206
STUDIO CITY CA
91604-2409
US

V. Phone/Fax

Practice location:
  • Phone: 818-508-8048
  • Fax:
Mailing address:
  • Phone: 818-508-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC18537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: