Provider Demographics
NPI:1083637938
Name:COUCH, STUART WALTON (MA)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:WALTON
Last Name:COUCH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 N CENTRAL EXPY STE 314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4132
Mailing Address - Country:US
Mailing Address - Phone:214-365-0777
Mailing Address - Fax:214-365-0778
Practice Address - Street 1:6440 N CENTRAL EXPY STE 314
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4132
Practice Address - Country:US
Practice Address - Phone:214-365-0777
Practice Address - Fax:214-365-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9451101YM0800X
TX7553101YP2500X
TX035207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist