MEDICARE: PATRICIA D PURNELL MA, LPC

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
1	101Y00000X	Counselor	178.022145	IL

General Provider Information

NPI Number	:	1487446860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA D PURNELL MA, LPC

Provider Business Mailing Address
First Line	:	159 1/2 S PRAIRIE AVE
Second Line	:
City	:	BRADLEY
State	:	IL
Zip	:	60915-2035
Country	:	US
Telephone Number	:	708-552-6647
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 ILLINOIS AVE
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-2420
Country	:	US
Telephone Number	:	630-549-6245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2025
Last Update Date	:	10/02/2025

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