Provider Demographics
NPI:1760112064
Name:PUTHUFF, TIERNEY
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:
Last Name:PUTHUFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23041 AVENIDA DE LA CARLOTA STE 175
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1588
Mailing Address - Country:US
Mailing Address - Phone:949-954-4422
Mailing Address - Fax:714-242-1611
Practice Address - Street 1:23041 AVENIDA DE LA CARLOTA STE 175
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1588
Practice Address - Country:US
Practice Address - Phone:949-954-4422
Practice Address - Fax:714-242-1611
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician