Healthcare Provider Details

I. General information

NPI: 1124433651
Provider Name (Legal Business Name): SHANELLE C PURDY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANELLE C HERNANDEZ LMHC

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-325 MOKILA PL
WAIANAE HI
96792-2850
US

IV. Provider business mailing address

87-325 MOKILA PL
WAIANAE HI
96792-2850
US

V. Phone/Fax

Practice location:
  • Phone: 808-864-6863
  • Fax:
Mailing address:
  • Phone: 808-864-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-861
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24838
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: