Provider Demographics
NPI:1700242583
Name:PURDUE, CHERYL (MFT)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:PURDUE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12444 VENTURA BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2409
Mailing Address - Country:US
Mailing Address - Phone:818-508-8048
Mailing Address - Fax:
Practice Address - Street 1:12444 VENTURA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2409
Practice Address - Country:US
Practice Address - Phone:818-508-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 18537OtherMFT LICENSE NUMBER