Provider Demographics
NPI:1326099045
Name:PUTNAM, CHARLES MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 SANDERS DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-6501
Mailing Address - Country:US
Mailing Address - Phone:901-268-4229
Mailing Address - Fax:901-476-5638
Practice Address - Street 1:74 SANDERS DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-6501
Practice Address - Country:US
Practice Address - Phone:901-268-4229
Practice Address - Fax:901-476-5638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000037201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical