MEDICARE: PUTNAM COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1093396319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUTNAM COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 12511
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22009-2511
Country	:	US
Telephone Number	:	616-826-6067
Fax Number	:

Provider Business Practice Location Address
First Line	:	5641 BURKE CENTRE PKWY STE 124
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-2259
Country	:	US
Telephone Number	:	571-314-5582
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CORIELLE PUTNAM
Credential	:	LPC
Telephone Number	:	616-826-6067

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/19/2021

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