Provider Demographics
NPI:1649846726
Name:PURCELL, ADAM RONALD (LCSW)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:RONALD
Last Name:PURCELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3659 S CREEKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6072
Mailing Address - Country:US
Mailing Address - Phone:208-982-0671
Mailing Address - Fax:
Practice Address - Street 1:161 E MALLARD DR STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5015
Practice Address - Country:US
Practice Address - Phone:208-203-2781
Practice Address - Fax:208-620-2306
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDLCSW-445431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical