Provider Demographics
NPI:1033419163
Name:PUTNAM, JACINTA RAE (MS, LPCC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JACINTA
Middle Name:RAE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MS, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 FRIBERG AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2306
Mailing Address - Country:US
Mailing Address - Phone:218-849-8685
Mailing Address - Fax:
Practice Address - Street 1:119 FRIBERG AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2306
Practice Address - Country:US
Practice Address - Phone:218-332-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN824101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional