Provider Demographics
NPI:1083770333
Name:COUTCHER, JUANITA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:MARIE
Last Name:COUTCHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:660-890-8186
Mailing Address - Fax:660-890-8186
Practice Address - Street 1:1091 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:LINN CREEK
Practice Address - State:MO
Practice Address - Zip Code:65052-1687
Practice Address - Country:US
Practice Address - Phone:573-346-6758
Practice Address - Fax:573-346-0621
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2459101YP2500X
MO2009012566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional