Provider Demographics
NPI:1841420213
Name:PURNELL, TRACY REGINA (MA)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:REGINA
Last Name:PURNELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21213 LITTLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-2326
Mailing Address - Country:US
Mailing Address - Phone:313-821-4525
Mailing Address - Fax:
Practice Address - Street 1:20490 HARPER AVE STE 102
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1645
Practice Address - Country:US
Practice Address - Phone:313-782-3914
Practice Address - Fax:313-513-3504
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health