Healthcare Provider Details

I. General information

NPI: 1619187721
Provider Name (Legal Business Name): SUZANNE MURPHY COYLE PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W 42ND ST
INDIANAPOLIS IN
46208-3301
US

IV. Provider business mailing address

3941GABLE LN CIR #727
INDIANAPOLIS IN
46228-6344
US

V. Phone/Fax

Practice location:
  • Phone: 317-931-2349
  • Fax: 317-931-2393
Mailing address:
  • Phone: 317-931-2349
  • Fax: 317-931-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0003
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0125
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: