Provider Demographics
NPI:1316546096
Name:PURRI, MICHELLE (LCPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PURRI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3626
Mailing Address - Country:US
Mailing Address - Phone:815-531-2454
Mailing Address - Fax:
Practice Address - Street 1:24012 W RENWICK RD STE 204
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-8733
Practice Address - Country:US
Practice Address - Phone:815-676-4688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional