Provider Demographics
NPI:1336327071
Name:ANNELIE S PURDY PHD INC
Entity Type:Organization
Organization Name:ANNELIE S PURDY PHD INC
Other - Org Name:ANNELIE S PURDY PHD
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNELIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-349-9706
Mailing Address - Street 1:433 SOUTH LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458
Mailing Address - Country:US
Mailing Address - Phone:805-349-9706
Mailing Address - Fax:805-349-0576
Practice Address - Street 1:433 SO LINCOLN STREET
Practice Address - Street 2:ANNELIE S PURDY PHD INC
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458
Practice Address - Country:US
Practice Address - Phone:805-349-9706
Practice Address - Fax:805-349-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL54520Medicaid
CA151010OtherVALUE OPTION
CA6128337OtherBLUE SHIELD UBH
CA151010OtherVALUE OPTION