Provider Demographics
NPI:1871274662
Name:GRAY PURCELL, JORDYN
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:GRAY PURCELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S RITTER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-7123
Mailing Address - Country:US
Mailing Address - Phone:317-296-3584
Mailing Address - Fax:
Practice Address - Street 1:400 S RITTER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-7210
Practice Address - Country:US
Practice Address - Phone:317-296-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist