Healthcare Provider Details

I. General information

NPI: 1265120182
Provider Name (Legal Business Name): SHANELLE PURDY LMHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANELLE PURDY
Title or Position: THERAPIST
Credential: LMHC
Phone: 808-864-6863