=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962489120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH LYNN SOUTHERLAND PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 NORTHLAND BLVD SUITE 102
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-3675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-670-9000
-----------------------------------------------------
Fax | 513-648-0156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1572 OTTERCREEK DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45240-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-674-0900
-----------------------------------------------------
Fax | 513-648-0156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 4118
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------