Provider Demographics
NPI:1194497354
Name:PURVIS, LEE NATHANIEL (PHD, LP, NCSP)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:NATHANIEL
Last Name:PURVIS
Suffix:
Gender:M
Credentials:PHD, LP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 BARKSDALE BLVD APT 1737
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4865
Mailing Address - Country:US
Mailing Address - Phone:919-215-8570
Mailing Address - Fax:
Practice Address - Street 1:13900 TECH CITY CIR STE 408
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6090
Practice Address - Country:US
Practice Address - Phone:386-518-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY-11023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist