Gregor James Putzka, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT 18538 Issued in CA

Practice address

130 Shangrila LN
Rogue River, OR 97537-9600

Phone

(831) 915-8648

Fax

(831) 625-4764

NPI assigned

Aug 2, 2006

Last updated

Sep 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1124035084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 SHANGRILA LN",
            "city": "ROGUE RIVER",
            "state": "OR",
            "postal_code": "975379600",
            "telephone_number": "831-915-8648",
            "fax_number": "831-625-4764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SHANGRILA LN",
            "city": "ROGUE RIVER",
            "state": "OR",
            "postal_code": "975379600",
            "telephone_number": "831-915-8648",
            "fax_number": "831-625-4764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTZKA",
        "first_name": "GREGOR",
        "middle_name": "JAMES",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "18538",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "LMFT 18538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Rogue River, OR
• Providers in Rogue River, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.