Provider Demographics
NPI:1184094823
Name:PURCELL, JENNIFER (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1723
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1723
Mailing Address - Country:US
Mailing Address - Phone:808-214-7307
Mailing Address - Fax:808-573-6091
Practice Address - Street 1:1135 MAKAWAO AVE STE 102
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7401
Practice Address - Country:US
Practice Address - Phone:808-214-7307
Practice Address - Fax:808-573-6091
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1727101YA0400X
HI460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)