Provider Demographics
NPI:1184863508
Name:SOUDER, SHIRLEY FAITH (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:FAITH
Last Name:SOUDER
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 COUNTY ROAD 29
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9608
Mailing Address - Country:US
Mailing Address - Phone:260-925-0798
Mailing Address - Fax:260-925-0798
Practice Address - Street 1:5613 COUNTY ROAD 29
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-9608
Practice Address - Country:US
Practice Address - Phone:260-925-0798
Practice Address - Fax:260-925-0798
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002624A1041C0700X
IN35001030A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist