Provider Demographics
NPI:1386702801
Name:PURISCH, ELLEN CAROL (LCSW MFT)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:CAROL
Last Name:PURISCH
Suffix:
Gender:F
Credentials:LCSW MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25282 ABILENE CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-831-9627
Mailing Address - Fax:
Practice Address - Street 1:23046 AVENIDA DE LA CARLOTA
Practice Address - Street 2:#600
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1548
Practice Address - Country:US
Practice Address - Phone:949-463-1774
Practice Address - Fax:949-282-5087
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS10522104100000X
CAMFC19098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist