Provider Demographics
NPI:1689488421
Name:PURPOSE DRIVEN INTERVENTION SERVICES
Entity type:Organization
Organization Name:PURPOSE DRIVEN INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:606-359-0700
Mailing Address - Street 1:9575 KY HWY 122 STE 6
Mailing Address - Street 2:ST 7
Mailing Address - City:EAST MCDOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647
Mailing Address - Country:US
Mailing Address - Phone:606-359-0700
Mailing Address - Fax:
Practice Address - Street 1:9575 KY HWY 122 STE 6
Practice Address - Street 2:ST 7
Practice Address - City:EAST MCDOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647
Practice Address - Country:US
Practice Address - Phone:606-359-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPOSE DRIVEN SUPPORT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty