Provider Demographics
NPI:1306268842
Name:PURDY ANGEJA, BRITTANY (MS)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:PURDY ANGEJA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1674
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-1674
Mailing Address - Country:US
Mailing Address - Phone:916-612-7064
Mailing Address - Fax:
Practice Address - Street 1:16 BRYSON DR
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685
Practice Address - Country:US
Practice Address - Phone:916-250-2587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75773106H00000X
CA108188106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist