Provider Demographics
NPI:1992910103
Name:PUTZ, MELODY A (LPC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:PUTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 29.5 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504
Mailing Address - Country:US
Mailing Address - Phone:970-254-4114
Mailing Address - Fax:970-254-4118
Practice Address - Street 1:510 29.5 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504
Practice Address - Country:US
Practice Address - Phone:970-254-4114
Practice Address - Fax:970-254-4118
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional