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Individual
MICHAEL PUCKETT
Active
Individual
MICHAEL PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.188652
OH
171M00000X
Case Manager/Care Coordinator
2022
OH
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
QMHS
OH
Other
Enumeration date
10/10/2022
Last updated
07/30/2024
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