Healthcare Provider Details

I. General information

NPI: 1558741082
Provider Name (Legal Business Name): BRIANNA PUETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 HARRISON AVE STE 300
COLUMBUS OH
43215-1346
US

IV. Provider business mailing address

401 NE 19TH AVE STE 200
PORTLAND OR
97232-4800
US

V. Phone/Fax

Practice location:
  • Phone: 614-259-8052
  • Fax:
Mailing address:
  • Phone: 503-298-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1600444
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1600444
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: