| Kathy Acus-souders, Psy.d., Llc | |
|
2188 Gateway Dr Fairborn OH 45324-6356 | |
| (937) 864-1940 | |
| (937) 864-1950 |
| Full Name | Kathy Acus-souders, Psy.d., Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2188 Gateway Dr, Fairborn, Ohio |
| Authorized Official Name and Position | Kathy Lynn Acus-souders (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 9378641940 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathy Acus-souders, Psy.d., Llc 2188 Gateway Dr Fairborn OH 45324-6356 Ph: (937) 864-1940 | Kathy Acus-souders, Psy.d., Llc 2188 Gateway Dr Fairborn OH 45324-6356 Ph: (937) 864-1940 |
| NPI Number | 1215112214 |
|---|---|
| Provider Enumeration Date | 01/08/2008 |
| Last Update Date | 11/26/2008 |
| Medicare PECOS PAC ID | 0143240879 |
|---|---|
| Medicare Enrollment ID | O20051128000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215112214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 5311 (Ohio) | Primary |
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