Provider Demographics
NPI:1225211246
Name:PURDY-LUXTON, YVONNE S
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:S
Last Name:PURDY-LUXTON
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:PO BOX 1039
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-1039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17913 HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:DULZURA
Practice Address - State:CA
Practice Address - Zip Code:91917-1207
Practice Address - Country:US
Practice Address - Phone:619-253-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health