Healthcare Provider Details

I. General information

NPI: 1902069461
Provider Name (Legal Business Name): DENISE ALINE PUTNAM MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2008
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S.W. PENN
BARTLESVILLE OK
74003
US

IV. Provider business mailing address

405 NE MYERS AVE
BARTLESVILLE OK
74006-1716
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax: 918-337-8099
Mailing address:
  • Phone: 918-766-5705
  • Fax: 918-331-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2308
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: