Most Relevant Information
Provider Data
| NPI Number: | 1003335100 |
| Provider Name: | ALYSHA JEAN PUCKETT BA, QMHS |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/11/2017 |
| Last Updated: | 09/11/2017 |
Provider Practice Location
710 N HIGH ST
MOUNT ORAB
OH
451548349
Practice Location Phone/Fax
| Phone: | 9374441613 |
| Fax: |
Provider Mailing Location
710 N HIGH ST
MOUNT ORAB
OH
451548349
Provider Mailing Phone/Fax
| Phone: | 9374441613 |
| Fax: |