Healthcare Provider Details

I. General information

NPI: 1215275748
Provider Name (Legal Business Name): ELIZABETH PUTNAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 CURTIS ST
MASON MI
48854-2545
US

IV. Provider business mailing address

812 E JOLLY RD SUITE 210
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-3401
  • Fax:
Mailing address:
  • Phone: 517-346-8000
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007396
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: