MEDICARE: SUZAN K COULTER LCMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	745	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366561839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZAN K COULTER LCMFT

Provider Business Mailing Address
First Line	:	11111 NALL AVE
Second Line	:	SUITE 112
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1625
Country	:	US
Telephone Number	:	913-593-9532
Fax Number	:	913-851-4002

Provider Business Practice Location Address
First Line	:	11111 NALL AVE
Second Line	:	SUITE 112
City	:	LEAWOOD
State	:	KS
Zip	:	66211-1625
Country	:	US
Telephone Number	:	913-593-9532
Fax Number	:	913-851-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	09/06/2012

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