Provider Demographics
NPI:1225753882
Name:PUTT, MORGAN LYN (CPSS)
Entity Type:Individual
Prefix:MISS
First Name:MORGAN
Middle Name:LYN
Last Name:PUTT
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EASTPORT ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38833-9334
Mailing Address - Country:US
Mailing Address - Phone:662-660-9447
Mailing Address - Fax:
Practice Address - Street 1:1000 STATE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9307
Practice Address - Country:US
Practice Address - Phone:662-286-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS667175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist