Provider Demographics
NPI:1831768647
Name:PURDY, MICHAEL BRUCE I (BS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:PURDY
Suffix:I
Gender:M
Credentials:BS
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Other - Credentials:
Mailing Address - Street 1:1884 CALLE YUCCA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2253
Mailing Address - Country:US
Mailing Address - Phone:805-558-6795
Mailing Address - Fax:
Practice Address - Street 1:2625 TOWNSGATE RD STE 102
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5726
Practice Address - Country:US
Practice Address - Phone:805-413-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician