Healthcare Provider Details

I. General information

NPI: 1720874621
Provider Name (Legal Business Name): BENJAMIN P PURSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N WALNUT ST
SPRINGFIELD IL
62702-5033
US

IV. Provider business mailing address

311 E UNION AVE
LITCHFIELD IL
62056-1519
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-7815
  • Fax:
Mailing address:
  • Phone: 618-960-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: