Healthcare Provider Details

I. General information

NPI: 1689583106
Provider Name (Legal Business Name): SUZANNE M KOETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W UNAKA AVE
JOHNSON CITY TN
37604-5507
US

IV. Provider business mailing address

100 W UNAKA AVE
JOHNSON CITY TN
37604-5507
US

V. Phone/Fax

Practice location:
  • Phone: 423-408-8041
  • Fax: 844-400-3966
Mailing address:
  • Phone: 423-408-8041
  • Fax: 844-400-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASSOCIATE
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: