Purple Willow Behavioral Health, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PURPLE WILLOW BEHAVIORAL HEALTH, LLC

Practice address

11452 Abner Ave
Fairfax, VA 22030-6029

Phone

(703) 623-5471

NPI assigned

Mar 9, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lindsey Colombo, BCBA, LBANPI 1699328872

Title

Owner

Phone

(703) 623-5471

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lindsey Colombo

  • Behavior Analyst
  • Fairfax, VA
  • NPI 1699328872
  NPD Authorized official
• Rachel Kinlaw, BCBA, LBA

  • Behavior Analyst
  • Fairfax, VA
  • NPI 1104591270
  NPD
• Malia Waller, M. ED, BCBA, LBA

  • Behavior Analyst
  • Warrenton, VA
  • NPI 1023860202
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615939200000",
    "number": "1366037517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11452 ABNER AVE",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306029",
            "telephone_number": "703-623-5471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11452 ABNER AVE",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306029",
            "telephone_number": "703-623-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURPLE WILLOW BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "COLOMBO",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-623-5471",
        "authorized_official_credential": "BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathy Podgorski Pumphrey, LPC
• Vipula Puntikura, PHYSICAL THERAPIST A
• Pure Movement Physical Therapy and Wellness LLC
• Vikas Puri
• Katherine M Purkert, LCSW
• Caitlin Pyne
• Daniel Hyo-Jin Pyon
• Makeez Asad Qaderi
• Enlin Qing
• Quality Hearts and Hands Healthcare LLC

• Community/Behavioral Health Agency in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.