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General NPI Number Information
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NPI Number | 1851808711
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Entity Type | Individual
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Provider Name | MOLLIE OLINE PUTYRAE LMHC MHP
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Gender | Female
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Dates
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Enumeration Date | 01/01/2018
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Last Update Date | 01/01/2018
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Provider Practice Location Address
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Address Line | 1404 E 11TH AVE
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City | SPOKANE
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State | WA
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Zip | 99202-3502
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Country | US
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Telephone | 509-744-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 E 34TH CT
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City | SPOKANE
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State | WA
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Zip | 99223-4676
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Country | US
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Telephone | 509-981-3104
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Fax |
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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 | LH60695074
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License Number State | WA
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