Provider Demographics
NPI:1174276323
Name:PUENTE, LUCY
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3085
Mailing Address - Country:US
Mailing Address - Phone:810-664-4646
Mailing Address - Fax:810-664-5181
Practice Address - Street 1:700 S MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3085
Practice Address - Country:US
Practice Address - Phone:810-664-4646
Practice Address - Fax:810-664-5181
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45-3623184OtherCHARITIES