Provider Demographics
NPI:1750591889
Name:PUTNAM, COURTNEY ERIN (LMP)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ERIN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 9TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5530
Mailing Address - Country:US
Mailing Address - Phone:206-228-9124
Mailing Address - Fax:
Practice Address - Street 1:603 DONOVAN AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7314
Practice Address - Country:US
Practice Address - Phone:206-228-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022487225700000X
WAMC61449596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist