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NPI Code Detail

MEDICARE: MICHELLE MANNINO-PURKEY MFT

MEDICARE: MICHELLE MANNINO-PURKEY MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist166.000851IL

General Provider Information

NPI Number : 1114298148
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE MANNINO-PURKEY MFT
Provider Business Mailing Address
First Line : 6232 N PULASKI RD STE 400
Second Line :
City : CHICAGO
State : IL
Zip : 60646-5133
Country : US
Telephone Number : 312-725-3093
Fax Number :
Provider Business Practice Location Address
First Line : 30 N MICHIGAN AVE STE 1217
Second Line :
City : CHICAGO
State : IL
Zip : 60602-3732
Country : US
Telephone Number : 312-725-3093
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2012
Last Update Date : 06/04/2024

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Directions to “ MICHELLE MANNINO-PURKEY MFT” Practice Location

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