Provider Demographics
NPI:1356390231
Name:DOLORES T PUTERBAUGH, LMHC PA
Entity type:Organization
Organization Name:DOLORES T PUTERBAUGH, LMHC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:T
Authorized Official - Last Name:PUTERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-559-0863
Mailing Address - Street 1:801 W BAY DR
Mailing Address - Street 2:SUITE 436
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3269
Mailing Address - Country:US
Mailing Address - Phone:727-559-0863
Mailing Address - Fax:727-393-9958
Practice Address - Street 1:801 W BAY DR
Practice Address - Street 2:SUITE 436
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3269
Practice Address - Country:US
Practice Address - Phone:727-559-0863
Practice Address - Fax:727-393-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5228101YM0800X
FLMT 2164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9797OtherBLUE CROSS/BLUE SHIELD ID