Provider Demographics
NPI:1174490692
Name:COUTURE, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:COUTURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 OCEAN PARK RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1657
Mailing Address - Country:US
Mailing Address - Phone:207-332-9653
Mailing Address - Fax:
Practice Address - Street 1:61 OCEAN PARK RD UNIT 5
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1657
Practice Address - Country:US
Practice Address - Phone:207-332-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty