Provider Demographics
NPI:1124516240
Name:PURCELL, JOHN BLAKE KEITH (LMFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BLAKE KEITH
Last Name:PURCELL
Suffix:
Gender:M
Credentials:LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79409-9803
Mailing Address - Country:US
Mailing Address - Phone:806-742-3674
Mailing Address - Fax:806-742-0260
Practice Address - Street 1:1003 FLINT AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409-9803
Practice Address - Country:US
Practice Address - Phone:806-742-3674
Practice Address - Fax:806-742-0260
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty