MEDICARE: EARL W PURPER 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
1	106H00000X	Marriage & Family Therapist	29408	CA

General Provider Information

NPI Number	:	1770629461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EARL W PURPER MFT

Provider Business Mailing Address
First Line	:	PO BOX 1164
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93456-1164
Country	:	US
Telephone Number	:	805-938-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 S MILLER ST STE G
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-6962
Country	:	US
Telephone Number	:	805-938-5801
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	06/15/2023

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