Healthcare Provider Details

I. General information

NPI: 1811769573
Provider Name (Legal Business Name): MATTHEW PURDY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 KATHY LN
CROSS LANES WV
25313-1285
US

IV. Provider business mailing address

36 KATHY LN
CROSS LANES WV
25313-1285
US

V. Phone/Fax

Practice location:
  • Phone: 304-786-2002
  • Fax:
Mailing address:
  • Phone: 304-786-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1084
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberM3A140800018
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: