Healthcare Provider Details

I. General information

NPI: 1407770373
Provider Name (Legal Business Name): ANNE SOUTER
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ANNIE SOUTER

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 DEWING AVE
LAFAYETTE CA
94549-4290
US

IV. Provider business mailing address

460 CENTER ST UNIT 6040
MORAGA CA
94570-5002
US

V. Phone/Fax

Practice location:
  • Phone: 925-322-0017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: