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General NPI Number Information
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NPI Number | 1386702801
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Entity Type | Individual
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Provider Name | ELLEN CAROL PURISCH LCSW MFT
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 23046 AVENIDA DE LA CARLOTA #600
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1548
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Country | US
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Telephone | 949-463-1774
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Fax | 949-282-5087
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Provider Business Mailing Address
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Address Line | 25282 ABILENE CT
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 949-831-9627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS10522
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC19098
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License Number State | CA
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