Basic Information
| Provider Information | |||||||||
| NPI: | 1124425988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PURKALL | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 FABLE AVE | ||||||||
| Address2: | APT. B | ||||||||
| City: | MANVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088352574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324919264 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2014 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 37PC00481800 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.