Provider Demographics
NPI:1548685720
Name:PURYEAR, MELISSA (MS, SSP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:MS, SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 CONGRESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-7908
Mailing Address - Country:US
Mailing Address - Phone:803-641-2624
Mailing Address - Fax:
Practice Address - Street 1:1000 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-2109
Practice Address - Country:US
Practice Address - Phone:803-641-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC232274103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool