Healthcare Provider Details

I. General information

NPI: 1134881865
Provider Name (Legal Business Name): SUZANNE KOELLING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 HAUSER ST
LENEXA KS
66215-4507
US

IV. Provider business mailing address

130 E 5TH ST
NEWTON KS
67114-2206
US

V. Phone/Fax

Practice location:
  • Phone: 913-766-1587
  • Fax: 913-766-1668
Mailing address:
  • Phone: 316-283-6743
  • Fax: 316-283-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03889
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: