Provider Demographics
NPI:1902310501
Name:SOUDER, EMILY (MED, LPCC-S, NCC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SOUDER
Suffix:
Gender:F
Credentials:MED, LPCC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 HENIZE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-9454
Mailing Address - Country:US
Mailing Address - Phone:513-399-7238
Mailing Address - Fax:
Practice Address - Street 1:8501 HENIZE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-9454
Practice Address - Country:US
Practice Address - Phone:513-399-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800578-SUPV101YP2500X, 101Y00000X, 101YM0800X
261QM0850X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259197Medicaid