Healthcare Provider Details

I. General information

NPI: 1992910103
Provider Name (Legal Business Name): MELODY A PUTZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 29.5 RD
GRAND JUNCTION CO
81504
US

IV. Provider business mailing address

510 29.5 RD
GRAND JUNCTION CO
81504
US

V. Phone/Fax

Practice location:
  • Phone: 970-254-4114
  • Fax: 970-254-4118
Mailing address:
  • Phone: 970-254-4114
  • Fax: 970-254-4118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3756
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: