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General NPI Number Information
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NPI Number | 1215112214
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Entity Type | Organization
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Legal Business Name | KATHY ACUS-SOUDERS, PSY.D., LLC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 2188 GATEWAY DR
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City | FAIRBORN
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State | OH
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Zip | 45324-6356
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Country | US
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Telephone | 937-864-1940
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Fax | 937-864-1950
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Provider Business Mailing Address
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Address Line | 2188 GATEWAY DR
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City | FAIRBORN
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State | OH
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Zip | 45324-6356
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Country | US
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Telephone | 937-864-1940
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Fax | 937-864-1950
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KATHY LYNN ACUS-SOUDERS
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Credential | PSY.D.
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Telephone | 937-864-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5311
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License Number State | OH
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