Provider Demographics
NPI:1760443683
Name:PURCELL, GWENN S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GWENN
Middle Name:S
Last Name:PURCELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7157
Mailing Address - Country:US
Mailing Address - Phone:406-600-2918
Mailing Address - Fax:
Practice Address - Street 1:2023 STADIUM DR
Practice Address - Street 2:SUITE 1C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-0613
Practice Address - Country:US
Practice Address - Phone:406-600-2918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical