Provider Demographics
NPI:1952127193
Name:PUTNEY, TINA MARTINA
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARTINA
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:MARTINA
Other - Last Name:PUTNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3410 OAKWOOD MALL DR STE 700
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2617
Mailing Address - Country:US
Mailing Address - Phone:715-832-6680
Mailing Address - Fax:
Practice Address - Street 1:3410 OAKWOOD MALL DR STE 700
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2617
Practice Address - Country:US
Practice Address - Phone:715-832-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor