Organization
PAYTONS PLACE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARLA SOUDER PSY.D., HSPP (OWNER/PRESIDENT/PSYCHOLOGIST)
(260) 498-9933
Entity
Organization
Contact information
Practice address
409 EAST COOK RD, SUITE 100, FORT WAYNE, IN 46825
(260) 498-9933
Mailing address
2599 COUNTY ROAD 72, AUBURN, IN 46706
(260) 498-9933
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042225A
IN
171M00000X
Case Manager/Care Coordinator
—
—
207Q00000X
Family Medicine Physician
—
—
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/13/2013
Last updated
12/13/2013
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