Provider Demographics
NPI:1184316366
Name:PURVIS, PAMELA KELLY (LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KELLY
Last Name:PURVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MCKEE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:815 EXCHANGE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-7020
Mailing Address - Country:US
Mailing Address - Phone:501-777-5969
Mailing Address - Fax:
Practice Address - Street 1:815 EXCHANGE AVE STE 109
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7020
Practice Address - Country:US
Practice Address - Phone:501-777-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1225101YP2500X
ARP2306003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional