Provider Demographics
NPI:1518255397
Name:PURO, ERIN GLORIA (PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GLORIA
Last Name:PURO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LORD NELSON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1910
Mailing Address - Country:US
Mailing Address - Phone:517-927-3740
Mailing Address - Fax:
Practice Address - Street 1:2149 JOLLY RD STE 500
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6028
Practice Address - Country:US
Practice Address - Phone:517-347-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1315103TC0700X
MI6301015537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical