Provider Demographics
NPI:1215380035
Name:COUCH, PHILIP RUSSELL (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:RUSSELL
Last Name:COUCH
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MAGNOLIA SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2228
Mailing Address - Country:US
Mailing Address - Phone:910-637-0210
Mailing Address - Fax:910-637-0210
Practice Address - Street 1:25 TURTLE POINT RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9520
Practice Address - Country:US
Practice Address - Phone:303-625-3694
Practice Address - Fax:910-637-0210
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOUC-MB64R9363LF0000X
NC5008779363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily