Provider Demographics
NPI:1720132434
Name:PURCELL, MICHAEL J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:PURCELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 W DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3327
Mailing Address - Country:US
Mailing Address - Phone:773-796-0747
Mailing Address - Fax:
Practice Address - Street 1:6832 W NORTH AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4430
Practice Address - Country:US
Practice Address - Phone:773-796-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical