Healthcare Provider Details

I. General information

NPI: 1497747513
Provider Name (Legal Business Name): DARRYL L PURE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE SUITE 2120
CHICAGO IL
60601-3901
US

IV. Provider business mailing address

333 N MICHIGAN AVE SUITE 2120
CHICAGO IL
60601-3901
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-6969
  • Fax: 847-410-7236
Mailing address:
  • Phone: 847-498-6969
  • Fax: 847-410-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071-002872
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071-002872
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071-002872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: