Healthcare Provider Details

I. General information

NPI: 1174523070
Provider Name (Legal Business Name): KATHY LYNN ACUS-SOUDERS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2188 GATEWAY DR
FAIRBORN OH
45324-6356
US

IV. Provider business mailing address

7 WHIPPOORWILL CT
ENON OH
45323-9792
US

V. Phone/Fax

Practice location:
  • Phone: 937-864-7122
  • Fax: 937-864-1950
Mailing address:
  • Phone: 937-864-1940
  • Fax: 937-864-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: