Doctor Name: | DR. KATHY LYNN ACUS-SOUDERS |
NPI Number: | 1174523070 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 5311 |
Business Practice Address: | 2188 Gateway Dr Fairborn, OH - 453246356 |
Business Phone Number: | 9378647122 |
Business Fax Number: | 9378641950 |
Mailing Address: | 7 Whippoorwill Ct, ENON |
State: | OH |
Postal Code: | 453239792 |
Phone Number: | 9378641940 |
Fax Number: | 9378641950 |
NPI Enumeration Date: | 07/21/2005 |
NPI Last Update Date: | 10/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 5311 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |