Provider Demographics
NPI:1851831903
Name:PURCELL, PATRICK JOSEPH (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOSEPH
Last Name:PURCELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5161 SOQUEL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2560
Mailing Address - Country:US
Mailing Address - Phone:408-378-7879
Mailing Address - Fax:
Practice Address - Street 1:5161 SOQUEL DR
Practice Address - Street 2:SUITE A
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2560
Practice Address - Country:US
Practice Address - Phone:408-378-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT19097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist