Provider Demographics
NPI:1508474578
Name:PURYEAR, NYCIA CELINA
Entity Type:Individual
Prefix:
First Name:NYCIA
Middle Name:CELINA
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ANDERSON CIR APT 109
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-7743
Mailing Address - Country:US
Mailing Address - Phone:857-615-8095
Mailing Address - Fax:
Practice Address - Street 1:612 ANDERSON CIR APT 109
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7743
Practice Address - Country:US
Practice Address - Phone:857-615-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
23-289516106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician