Provider Demographics
NPI:1104126689
Name:PUTZEL, MICHAEL (MA, LPC, ATR)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PUTZEL
Suffix:
Gender:M
Credentials:MA, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1417
Mailing Address - Country:US
Mailing Address - Phone:720-598-2798
Mailing Address - Fax:720-528-7817
Practice Address - Street 1:815 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1417
Practice Address - Country:US
Practice Address - Phone:720-598-2798
Practice Address - Fax:720-528-7817
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134824TELE101YM0800X
CO6129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health