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NPI Code Detail

MEDICARE: MS. TERESA RENE SUTHERLIN LCP

MEDICARE:  MS. TERESA RENE SUTHERLIN  LCP
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
1103TP2701XGroup Psychotherapy PsychologistLCP 069KS

General Provider Information

NPI Number : 1942425483
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERESA RENE SUTHERLIN LCP
Provider Business Mailing Address
First Line : 613 N 12TH ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-5227
Country : US
Telephone Number : 620-275-1712
Fax Number :
Provider Business Practice Location Address
First Line : 531 CAMPUS VIEW ST
Second Line :
City : GARDEN CITY
State : KS
Zip : 67846-7904
Country : US
Telephone Number : 620-275-0644
Fax Number : 620-272-0239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 07/08/2007

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Directions to “ MS. TERESA RENE SUTHERLIN LCP” Practice Location

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