Basic Information
| Provider Information | |||||||||
| NPI: | 1902069461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUTNAM | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | ALINE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 NE MYERS AVE | ||||||||
| Address2: | |||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740061716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187665705 | ||||||||
| FaxNumber: | 9183313584 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 S.W. PENN | ||||||||
| Address2: | |||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183378080 | ||||||||
| FaxNumber: | 9183378099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2008 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2308 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.