Provider Demographics
NPI:1619393600
Name:PUTZ, CHERELLE (RDH, MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHERELLE
Middle Name:
Last Name:PUTZ
Suffix:
Gender:F
Credentials:RDH, MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1464
Mailing Address - Country:US
Mailing Address - Phone:248-877-8269
Mailing Address - Fax:
Practice Address - Street 1:1250 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1464
Practice Address - Country:US
Practice Address - Phone:248-877-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014108101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor