Healthcare Provider Details

I. General information

NPI: 1275709693
Provider Name (Legal Business Name): MARTHA PURCELL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BELMONT AVE STE 3
SOMERSET KY
42501-2428
US

IV. Provider business mailing address

PO BOX 3044
WEST SOMERSET KY
42564-3044
US

V. Phone/Fax

Practice location:
  • Phone: 606-687-2038
  • Fax: 606-200-3654
Mailing address:
  • Phone: 606-687-2038
  • Fax: 606-200-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104128
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: