Provider Demographics
NPI:1679079651
Name:TANYA M. PURCELL
Entity type:Organization
Organization Name:TANYA M. PURCELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:419-304-6895
Mailing Address - Street 1:3816 SCHNEIDER RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3652
Mailing Address - Country:US
Mailing Address - Phone:419-304-6895
Mailing Address - Fax:
Practice Address - Street 1:1627 HENTHORNE DR STE D
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1370
Practice Address - Country:US
Practice Address - Phone:419-304-6895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1100246SUPV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)