Provider Demographics
NPI:1194251413
Name:PUTNAM, CORIELLE (LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:CORIELLE
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 OAK CT STE 310
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1063
Mailing Address - Country:US
Mailing Address - Phone:937-705-6040
Mailing Address - Fax:571-316-1854
Practice Address - Street 1:1430 OAK CT STE 310
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-1063
Practice Address - Country:US
Practice Address - Phone:937-705-6040
Practice Address - Fax:571-316-1854
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 15064101YM0800X
VA0701010074101YM0800X
OHE.2202964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health