Provider Demographics
NPI:1033369053
Name:PUTNAM COLE, ASHLEY A (OQMHP-COMMUNITY)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:PUTNAM COLE
Suffix:
Gender:F
Credentials:OQMHP-COMMUNITY
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 EDGEMONT DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2036
Mailing Address - Country:US
Mailing Address - Phone:207-762-3310
Mailing Address - Fax:207-762-3307
Practice Address - Street 1:1 EDGEMONT DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2036
Practice Address - Country:US
Practice Address - Phone:207-762-3310
Practice Address - Fax:207-762-3307
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000OtherMAINECARE