Provider Demographics
NPI:1033352406
Name:PUTNAM, ED (LMHP, CPC)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:LMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 EAST AVE
Mailing Address - Street 2:PO BOX 56
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2314
Mailing Address - Country:US
Mailing Address - Phone:308-995-9399
Mailing Address - Fax:308-995-9399
Practice Address - Street 1:603 EAST AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2314
Practice Address - Country:US
Practice Address - Phone:308-995-9399
Practice Address - Fax:308-995-9399
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE26-3640642OtherEIN