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General NPI Number Information
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NPI Number | 1770803322
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Entity Type | Individual
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Provider Name | CLARALICE PUTNAM M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2010
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Last Update Date | 07/05/2010
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Provider Practice Location Address
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Address Line | 124 S BROADWAY AVE AMERICAN BUILDING-SUITE 406
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City | ADA
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State | OK
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Zip | 74820-5820
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Country | US
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Telephone | 580-310-4750
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Fax | 580-559-2223
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Provider Business Mailing Address
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Address Line | 1800 E 18TH ST
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City | ADA
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State | OK
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Zip | 74820-7115
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Country | US
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Telephone | 580-310-4750
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Fax | 580-559-2223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2311
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License Number State | OK
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