Provider Demographics
NPI:1699822841
Name:PUTMAN, TIMOTHY DAVID (LMHC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 ROSEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5643
Mailing Address - Country:US
Mailing Address - Phone:850-248-8553
Mailing Address - Fax:
Practice Address - Street 1:2611 N HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5859
Practice Address - Country:US
Practice Address - Phone:850-276-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health