Provider Demographics
NPI:1841809050
Name:PUTMAN, STEPHANIE ANN (LPC)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANN
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 KIERSTED ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1939
Mailing Address - Country:US
Mailing Address - Phone:815-280-8718
Mailing Address - Fax:
Practice Address - Street 1:295 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1581
Practice Address - Country:US
Practice Address - Phone:815-515-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional