Healthcare Provider Details

I. General information

NPI: 1255248308
Provider Name (Legal Business Name): DENISE PURVIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E STATE ST STE 202
ROCKFORD IL
61108-2392
US

IV. Provider business mailing address

5301 E STATE ST STE 202
ROCKFORD IL
61108-2392
US

V. Phone/Fax

Practice location:
  • Phone: 815-226-8146
  • Fax:
Mailing address:
  • Phone: 815-226-8146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DENISE PURVIS
Title or Position: OWNER
Credential: MS LCPC
Phone: 815-226-8146