Healthcare Provider Details

I. General information

NPI: 1508902206
Provider Name (Legal Business Name): LYNN SOUCHAL KUTTNAUER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31805 MIDDLEBELT RD SUITE 302
FARMINGTON HILLS MI
48334-2367
US

IV. Provider business mailing address

31805 MIDDLEBELT RD SUITE 302
FARMINGTON HILLS MI
48334-2367
US

V. Phone/Fax

Practice location:
  • Phone: 248-737-9890
  • Fax:
Mailing address:
  • Phone: 248-737-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301002684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: