Provider Demographics
NPI:1174938617
Name:PURNELL, TAHNA (LCPC)
Entity type:Individual
Prefix:
First Name:TAHNA
Middle Name:
Last Name:PURNELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4171
Mailing Address - Country:US
Mailing Address - Phone:410-371-6456
Mailing Address - Fax:
Practice Address - Street 1:8930 CHURCH LN
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4171
Practice Address - Country:US
Practice Address - Phone:410-371-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional