Provider Demographics
NPI:1144535527
Name:PURKISS, JESSICA LEIGH
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:PURKISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-0658
Mailing Address - Country:US
Mailing Address - Phone:909-336-1800
Mailing Address - Fax:
Practice Address - Street 1:28545 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:SKYFOREST
Practice Address - State:CA
Practice Address - Zip Code:92385
Practice Address - Country:US
Practice Address - Phone:909-336-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)