Provider Demographics
NPI:1487446860
Name:PURNELL, PATRICIA D (LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:PURNELL
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 1/2 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2035
Mailing Address - Country:US
Mailing Address - Phone:708-552-6647
Mailing Address - Fax:
Practice Address - Street 1:3755 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2420
Practice Address - Country:US
Practice Address - Phone:630-549-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program