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General NPI Number Information
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NPI Number | 1174941066
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Entity Type | Organization
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Legal Business Name | KELLEE PURDY, LLC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 1832 NE BROADWAY ST
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City | PORTLAND
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State | OR
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Zip | 97232-1992
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Country | US
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Telephone | 971-227-9277
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 SE 64TH AVE
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City | PORTLAND
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State | OR
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Zip | 97206-1373
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Country | US
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Telephone | 971-227-9277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLEE PURDY
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Credential | LCSW
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Telephone | 971-227-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4182
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License Number State | OR
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