Healthcare Provider Details

I. General information

NPI: 1699822841
Provider Name (Legal Business Name): TIMOTHY DAVID PUTMAN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 N HIGHWAY 231
PANAMA CITY FL
32405-5859
US

IV. Provider business mailing address

3509 ROSEWOOD CIR
LYNN HAVEN FL
32444-5643
US

V. Phone/Fax

Practice location:
  • Phone: 850-276-3351
  • Fax:
Mailing address:
  • Phone: 850-248-8553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 3803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: