Healthcare Provider Details

I. General information

NPI: 1619393600
Provider Name (Legal Business Name): CHERELLE PUTZ RDH, MA, LLPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 COTTONWOOD ST
LAKE ORION MI
48360-1464
US

IV. Provider business mailing address

1250 COTTONWOOD ST
LAKE ORION MI
48360-1464
US

V. Phone/Fax

Practice location:
  • Phone: 248-877-8269
  • Fax:
Mailing address:
  • Phone: 248-877-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401014108
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: