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General NPI Number Information
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NPI Number | 1518165695
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Entity Type | Individual
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Provider Name | SUSAN ELAINE COULTER LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 296 W. SUNSET AVE STE 15
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8366
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Country | US
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Telephone | 208-666-0357
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Fax | 208-666-0468
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Provider Business Mailing Address
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Address Line | 296 W. SUNSET AVE STE 15
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8366
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Country | US
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Telephone | 208-889-1897
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Fax | 208-210-3840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00009445
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-28136
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License Number State | ID
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