=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013883826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIPPEWA VALLEY COUNSELING CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2725 MALL DR
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-6835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-895-7115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1324 W CLAIREMONT AVE STE 6
-----------------------------------------------------
City | EAU CLAIRE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54701-6191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-895-7115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. SHAUNA PUTZY
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 715-895-7115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------