Individual
PEGGY A SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMFT
Contact information
Practice address
2537 EISENHOWER RD, OTTAWA, KS 66067-9482
(785) 242-3780
(785) 242-6397
Mailing address
PO BOX 677, OTTAWA, KS 66067-0677
(785) 242-3780
(785) 242-6397
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LCMFT 673
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200431710A
—
KS
Enumeration date
07/17/2006
Last updated
01/09/2012
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