Provider Demographics
NPI:1235246638
Name:COUCH, ANNA JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JANE
Last Name:COUCH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-0497
Mailing Address - Country:US
Mailing Address - Phone:909-860-1541
Mailing Address - Fax:909-861-6473
Practice Address - Street 1:1370 VALLEY VISTA DR STE 200
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3921
Practice Address - Country:US
Practice Address - Phone:909-860-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist