Provider Demographics
NPI:1285642157
Name:PURVIS, DENISE LYNN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:PURVIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 EAST STATE STREET #202
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108
Mailing Address - Country:US
Mailing Address - Phone:815-226-8146
Mailing Address - Fax:815-977-5929
Practice Address - Street 1:5301 EAST STATE STREET #202
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108
Practice Address - Country:US
Practice Address - Phone:815-226-8146
Practice Address - Fax:815-977-5929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health