Provider Demographics
NPI:1508902206
Name:KUTTNAUER, LYNN SOUCHAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:SOUCHAL
Last Name:KUTTNAUER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31805 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2367
Mailing Address - Country:US
Mailing Address - Phone:248-737-9890
Mailing Address - Fax:
Practice Address - Street 1:31805 MIDDLEBELT RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2367
Practice Address - Country:US
Practice Address - Phone:248-737-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002684103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
25592000OtherMAGELLAN
117402OtherVALUE OPTIONS