Provider Demographics
NPI:1366694986
Name:PURYEAR, CHERYL VANESSA (MSCP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:VANESSA
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6814
Mailing Address - Country:US
Mailing Address - Phone:907-357-4108
Mailing Address - Fax:907-357-4178
Practice Address - Street 1:5851 E MAYFLOWER CT
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7881
Practice Address - Country:US
Practice Address - Phone:907-357-6808
Practice Address - Fax:907-373-1135
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health