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General NPI Number Information
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NPI Number | 1114337516
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Entity Type | Organization
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Legal Business Name | PUTNAM PSYCHOTHERAPY
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 918 SAINT JOHNS AVE
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City | PALATKA
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State | FL
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Zip | 32177-4650
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Country | US
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Telephone | 386-385-3887
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Fax | 386-385-3922
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Provider Business Mailing Address
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Address Line | 918 SAINT JOHNS AVE
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City | PALATKA
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State | FL
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Zip | 32177-4650
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Country | US
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Telephone | 386-385-3887
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Fax | 386-385-3922
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CINDY DOREEN SHARPE
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Credential |
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Telephone | 386-385-3887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 5246
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License Number State | FL
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