Provider Demographics
NPI:1316379290
Name:PURCELL, ERICKA BROOKE (LMFT)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:BROOKE
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MARKET ST
Mailing Address - Street 2:B183
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3850
Mailing Address - Country:US
Mailing Address - Phone:316-660-9484
Mailing Address - Fax:316-660-9498
Practice Address - Street 1:130 S MARKET ST
Practice Address - Street 2:B183
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3850
Practice Address - Country:US
Practice Address - Phone:316-660-9484
Practice Address - Fax:316-660-9498
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist