Provider Demographics
NPI:1952093452
Name:COUGHLIN, AMBER MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:LUSSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1226 N SHEFFORD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5667
Mailing Address - Country:US
Mailing Address - Phone:765-480-7533
Mailing Address - Fax:
Practice Address - Street 1:7570 W 21ST ST N # 1042
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:765-480-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS117201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical