Provider Demographics
NPI:1922553791
Name:PURDY INC
Entity type:Organization
Organization Name:PURDY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BERNHARDT-PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LMSW, LPC, LAC
Authorized Official - Phone:620-208-9049
Mailing Address - Street 1:902 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2917
Mailing Address - Country:US
Mailing Address - Phone:620-208-9049
Mailing Address - Fax:620-208-9049
Practice Address - Street 1:902 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2917
Practice Address - Country:US
Practice Address - Phone:620-208-9049
Practice Address - Fax:620-208-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS750101YP2500X
KS4910251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty