Provider Demographics
NPI:1780847285
Name:PURDY, KELLEE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLEE
Middle Name:
Last Name:PURDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BEHRENDS AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1415
Mailing Address - Country:US
Mailing Address - Phone:971-227-9277
Mailing Address - Fax:888-976-5806
Practice Address - Street 1:205 BEHRENDS AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1415
Practice Address - Country:US
Practice Address - Phone:971-227-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1940051041C0700X
ORL41821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500669839OtherDMAP (OREGON HEALTH PLAN)