Provider Demographics
NPI:1679730550
Name:PURCELL, STEPHEN LENNARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LENNARD
Last Name:PURCELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S MAIN ST
Mailing Address - Street 2:STE.214
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2117
Mailing Address - Country:US
Mailing Address - Phone:734-663-1272
Mailing Address - Fax:
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:STE.214
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2117
Practice Address - Country:US
Practice Address - Phone:734-663-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H146990OtherBLUE CROSS AND BLUE SHIELD PIN NUMBER