Provider Demographics
NPI:1427282797
Name:PUTNAM, COURTNEY C (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:C
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 WOODSTOCK PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4869
Mailing Address - Country:US
Mailing Address - Phone:678-653-3272
Mailing Address - Fax:
Practice Address - Street 1:970 WOODSTOCK PKWY STE 210
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4869
Practice Address - Country:US
Practice Address - Phone:678-653-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007927101YP2500X
LA1098106H00000X
TX64181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist