Provider Demographics
NPI:1164939286
Name:SOULIERE, KOURTNI COLLEEN (LMHC)
Entity Type:Individual
Prefix:
First Name:KOURTNI
Middle Name:COLLEEN
Last Name:SOULIERE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KOURTNI
Other - Middle Name:COLLEEN
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 US OVAL STE 100
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12903-5901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL STE 100
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5901
Practice Address - Country:US
Practice Address - Phone:518-563-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health