| Eileen Purdy Llc | |
|
1200 28th St Street Boulder CO 80303-1756 | |
| (503) 320-0334 | |
| Not Available |
| Full Name | Eileen Purdy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 28th St Street, Boulder, Colorado |
| Authorized Official Name and Position | Eileen Purdy (OWNER/MBH) |
| Authorized Official Contact | 5033200334 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eileen Purdy Llc 403 Hurricane Hill Drive Nederland CO 80466-9730 Ph: (503) 320-0334 | Eileen Purdy Llc 1200 28th St Street Boulder CO 80303-1756 Ph: (503) 320-0334 |
| NPI Number | 1003408626 |
|---|---|
| Provider Enumeration Date | 02/04/2021 |
| Last Update Date | 09/09/2021 |
| Certification Date | 09/09/2021 |
| Medicare PECOS PAC ID | 4789092099 |
|---|---|
| Medicare Enrollment ID | O20210426000635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003408626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Eileen Purdy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922690544 PECOS PAC ID: 8325456643 Enrollment ID: I20210426001172 |
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