Provider Demographics
NPI:1366561839
Name:COULTER, SUZAN K (LCMFT)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:K
Last Name:COULTER
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 NALL AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1625
Mailing Address - Country:US
Mailing Address - Phone:913-593-9532
Mailing Address - Fax:913-851-4002
Practice Address - Street 1:11111 NALL AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1625
Practice Address - Country:US
Practice Address - Phone:913-593-9532
Practice Address - Fax:913-851-4002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100117700AMedicaid