Provider Demographics
NPI:1497846950
Name:SOUKUP, DOROTHY THERESE (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:THERESE
Last Name:SOUKUP
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2385 TROOP DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:320-253-2385
Mailing Address - Fax:320-253-2386
Practice Address - Street 1:2385 TROOP DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-253-2385
Practice Address - Fax:320-253-2386
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP3278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN991437400Medicaid
MN991437400Medicaid