Provider Demographics
NPI:1699891754
Name:PUTT, CHERYLL LA VONNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYLL
Middle Name:LA VONNE
Last Name:PUTT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16776 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2534
Mailing Address - Country:US
Mailing Address - Phone:858-451-9929
Mailing Address - Fax:858-451-9929
Practice Address - Street 1:1371 CORTE BAGALSO
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7392
Practice Address - Country:US
Practice Address - Phone:858-603-5759
Practice Address - Fax:858-451-9929
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health