Individual
ROBERT PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MFT
Contact information
Practice address
2302 SE SALMON ST, PORTLAND, OR 97214-3944
(323) 217-3460
Mailing address
1208 SE 23RD AVE, PORTLAND, OR 97214-3905
(323) 217-3460
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
70245
CA
Other
Enumeration date
09/01/2016
Last updated
06/09/2019
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