Provider Demographics
NPI:1861683294
Name:DUTCHER, SUSAN (PSYD, T-LP, LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DUTCHER
Suffix:
Gender:F
Credentials:PSYD, T-LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 E
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206
Mailing Address - Country:US
Mailing Address - Phone:316-293-2647
Mailing Address - Fax:
Practice Address - Street 1:1204 BSELOUIS DR
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110
Practice Address - Country:US
Practice Address - Phone:316-351-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1982103TC0700X
KS1914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical