Provider Demographics
NPI:1275202053
Name:PURVES, JAIMELYN KUUIPOLANI (MA, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:JAIMELYN
Middle Name:KUUIPOLANI
Last Name:PURVES
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SPRING ST APT 331
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4447
Mailing Address - Country:US
Mailing Address - Phone:612-749-1957
Mailing Address - Fax:
Practice Address - Street 1:400 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4437
Practice Address - Country:US
Practice Address - Phone:612-749-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304319101YA0400X
MNCC02834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)