Provider Demographics
NPI:1053633198
Name:DESICOUCH
Entity Type:Organization
Organization Name:DESICOUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DESDEMONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-267-4850
Mailing Address - Street 1:61 AIRPORT BLVD
Mailing Address - Street 2:STE. C
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-6522
Mailing Address - Country:US
Mailing Address - Phone:415-267-4850
Mailing Address - Fax:415-267-4850
Practice Address - Street 1:61 AIRPORT BLVD.
Practice Address - Street 2:STE. C
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080
Practice Address - Country:US
Practice Address - Phone:415-267-4850
Practice Address - Fax:415-267-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43971251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health