Provider Demographics
NPI:1336495233
Name:PUTNAM, PATRICIA EILEEN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:EILEEN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 MARKET PL
Mailing Address - Street 2:J104
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3352
Mailing Address - Country:US
Mailing Address - Phone:916-337-2546
Mailing Address - Fax:
Practice Address - Street 1:615 MARKET ST
Practice Address - Street 2:SUITE D
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5422
Practice Address - Country:US
Practice Address - Phone:916-337-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60534861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical