Provider Demographics
NPI:1225504608
Name:SERENITY MENTAL AND MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:SERENITY MENTAL AND MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:303-625-3694
Mailing Address - Street 1:25 TURTLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9520
Mailing Address - Country:US
Mailing Address - Phone:303-625-3694
Mailing Address - Fax:910-420-2428
Practice Address - Street 1:430 MAGNOLIA SQUARE CT
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2228
Practice Address - Country:US
Practice Address - Phone:303-625-3694
Practice Address - Fax:910-420-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty