Individual
THOMAS PUTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
210 W BURNSIDE AVE STE A, CHUBBUCK, ID 83202-4916
(208) 238-9000
Mailing address
210 W BURNSIDE AVE STE A, CHUBBUCK, ID 83202-4916
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5049
ID
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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