MEDICARE: MARK PUTNOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	195	CO

General Provider Information

NPI Number	:	1073955373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PUTNOY

Provider Business Mailing Address
First Line	:	PO BOX 631325
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80163-1325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8805 W 14TH AVE STE 300
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80215-4848
Country	:	US
Telephone Number	:	720-943-7080
Fax Number	:	720-316-7577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2013
Last Update Date	:	08/16/2022

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Directions to “ MARK PUTNOY ” Practice Location

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