1063489185 NPI number — DR. HEATHER DEE PURCELL PSY.D.

Table of content: DR. HEATHER DEE PURCELL PSY.D. (NPI 1063489185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063489185 NPI number — DR. HEATHER DEE PURCELL PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURCELL
Provider First Name:
HEATHER
Provider Middle Name:
DEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PURCELL
Provider Other First Name:
HEATHER
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063489185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 HARMON AVE
Provider Second Line Business Mailing Address:
WINN ARMY COMMUNITY HOSPITAL SUITE 1D03
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-435-6965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1061 HARMON AVE
Provider Second Line Business Practice Location Address:
SUITE 1D03
Provider Business Practice Location Address City Name:
FORT STEWART
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31314-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-6965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2570 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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