Provider Demographics
NPI:1780892604
Name:COUTURE, CARRIE DAWN (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:DAWN
Last Name:COUTURE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2118 N TYLER RD
Mailing Address - Street 2:BUILDING B SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2037
Mailing Address - Country:US
Mailing Address - Phone:316-779-2564
Mailing Address - Fax:316-779-2564
Practice Address - Street 1:2118 N TYLER RD
Practice Address - Street 2:BUILDING B SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2037
Practice Address - Country:US
Practice Address - Phone:316-779-2564
Practice Address - Fax:316-779-2564
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS35641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical