Active NPI
Brian William Putz, MA, LP
- Psychologist
- Brooklyn Center, MN
National Provider Identifier
1720155823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP3322
- Practice address
- 6200 Shingle Creek Pkwy Ste 455
Brooklyn Center, MN 55430-2178 - Phone
- (763) 503-8560
- Fax
- (763) 503-8563
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP3322 | MN | Primary |
Addresses
Primary practice location
6200 Shingle Creek Pkwy Ste 455
Brooklyn Center, MN 55430-2178
Mailing address
15873 Crane St NW
Andover, MN 55304-4560
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 657T1PU | Other | MN | BCBS MN |
| HP31888 | Other | MN | HEALTH PARTNERS |
| 1021025 | Other | MN | CIGNA |
| 62-50561 | Other | MN | MEDICA UBH |
| 990991031581 | Other | MN | BHP PREFERRED 1 |
| 141966 | Other | MN | U CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3322 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720155823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15873 CRANE ST NW",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553044560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 SHINGLE CREEK PKWY STE 455",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302178",
"telephone_number": "763-503-8560",
"fax_number": "763-503-8563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTZ",
"first_name": "BRIAN",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "MA, LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP3322",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN",
"identifier": "657T1PU",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP31888",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1021025",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA UBH",
"identifier": "62-50561",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BHP PREFERRED 1",
"identifier": "990991031581",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U CARE",
"identifier": "141966",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.