Healthcare Provider Details

I. General information

NPI: 1033352406
Provider Name (Legal Business Name): ED PUTNAM LMHP, CPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 EAST AVE
HOLDREGE NE
68949-2314
US

IV. Provider business mailing address

603 EAST AVE PO BOX 56
HOLDREGE NE
68949-2314
US

V. Phone/Fax

Practice location:
  • Phone: 308-995-9399
  • Fax: 308-995-9399
Mailing address:
  • Phone: 308-995-9399
  • Fax: 308-995-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1507
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: