Healthcare Provider Details

I. General information

NPI: 1992539910
Provider Name (Legal Business Name): DAVID LOREN PUTNEY MS, CRC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W HILL TER
PAINTED POST NY
14870-1002
US

IV. Provider business mailing address

124 W HILL TER
PAINTED POST NY
14870-1002
US

V. Phone/Fax

Practice location:
  • Phone: 585-362-0060
  • Fax:
Mailing address:
  • Phone: 585-362-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: