Provider Demographics
NPI:1871083469
Name:PURVIS, SKYLAR JAMES (RMHCI, RMFTI)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:JAMES
Last Name:PURVIS
Suffix:
Gender:M
Credentials:RMHCI, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CELEBRATION AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4862
Mailing Address - Country:US
Mailing Address - Phone:850-368-7447
Mailing Address - Fax:
Practice Address - Street 1:2479 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:497-657-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-53308106S00000X
106S00000X
FLIMH22549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH22549OtherSTATE OF FLORIDA
RBT-18-53308OtherRBT
FL022030900Medicaid