Individual
MS. CLARALICE PUTNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., LPC
Contact information
Practice address
124 S BROADWAY AVE, AMERICAN BUILDING-SUITE 406, ADA, OK 74820-5820
(580) 310-4750
(580) 559-2223
Mailing address
1800 E 18TH ST, ADA, OK 74820-7115
(580) 310-4750
(580) 559-2223
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2311
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200051000 B
—
OK
Enumeration date
06/06/2010
Last updated
07/05/2010
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