Provider Demographics
NPI:1073946828
Name:PURVIS, HAILEY LILITH
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:LILITH
Last Name:PURVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6018
Mailing Address - Country:US
Mailing Address - Phone:229-560-9629
Mailing Address - Fax:
Practice Address - Street 1:1406 HAYS ST
Practice Address - Street 2:SUITE 8
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2833
Practice Address - Country:US
Practice Address - Phone:850-521-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst