Provider Demographics
NPI:1285463752
Name:PURCELL, MARTI
Entity type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 GLEN SPRING DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1309
Mailing Address - Country:US
Mailing Address - Phone:832-264-5028
Mailing Address - Fax:
Practice Address - Street 1:6005 WINDWARD FALLS WAY
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-1899
Practice Address - Country:US
Practice Address - Phone:903-452-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator